Case Studies 25 : Case of aortic stenosis
This is a case of a male age 27 years. He has a square face with specs mounted on eyes. He came with the diagnosis of Severe calcified Aortic stenosis. Complaints started with dyspnoea 4 yrs back associated with giddiness. It was not not taken much care of. 6 months before he had a fainting attack which was just termed as a syncopal attack with no proper diagnosis. There after complaints became severe in last 2 month which use to increase with ascending stairs, exertion and with emotional stress. Investigations were done including CT scan, MRI, 2Decho in ruby hall clinic which diagnosed it to be having severe aortic stenosis which were causing the complaints. He was asked to do valve replacement within a week. Brain scans were normal. Associated with this he had the complaint of headache frequently which was diagnosed as migraine which he was suffering from last 10years.
Pathology…
Aortic stenosis is the narrowing of the exit of the left ventricle of the heart (where the aorta begins), such that problems result. It may occur at the aortic valve as well as above and below this level. It typically gets worse over time. Symptoms often come on gradually with a decreased ability to exercise often occurring first. If heart failure, loss of conciousness, or heart related chest pain occurs due to AS the outcomes are worse. Loss of consciousness typically occurs with standing or exercise. Signs of heart failure include shortness of breath especially when lying down, at night, or with exercise, and swelling of the legs. Thickening of the valve without narrowing is known as aortic sclerosis.
Causes include being born with a bicuspid aortic valve and rheumatic fever. A bicuspid aortic valve affects about one to two percent of the population while rheumatic heart disease mostly occurring in the developing world. A normal valve, however, may also harden over the decades. Risk factors are similar to those of coronary artery disease and include smoking, high blood pressure, high cholesterol, diabetes, and being male. The aortic valve usually has three leaflets and is located between the left ventricle of the heart and the aorta. AS typically results in a heart murmur. Its severity can be divided into mild, moderate, severe, and very severe based on ultrasound of the heart findings.
Since the stenosed aortic valve may limit the heart's output, people with aortic stenosis are at risk of syncope and dangerously low blood pressure should they use any of a number of medications for cardiovascular diseases that often coexist with aortic stenosis. Examples include nitroglycerin, nitrates, ACE inhibitors, terazosin (Hytrin), and hydralazine. Note that all of these substances lead to peripheral vasodilation. Under normal circumstances, in the absence of aortic stenosis, the heart is able to increase its output and thereby offset the effect of the dilated blood vessels. In some cases of aortic stenosis, however, due to the obstruction of blood flow out of the heart caused by the stenosed aortic valve, cardiac output cannot be increased. Low blood pressure or syncope may ensue.
Remedy:- Spigelia 30 (22 Aug 2015), N.V (9 Oct 2015),
ANT TART (16 Jun 2016)
K/C/O:-
Aortic stenosis
Migraine.
Investigation :-
2-D Echo
- Bicuspid Aortic valve.
- Severe calcified Aortic stenosis.
- Mild aortic regurgitation
- LV hypertrophy.
- LVEF - 65%.
- Advice - Aortic valve Replacement.
Chief/Complaints :-
1. Breathlessness since 4 yrs – increased 2 Month.
2. Palpitation since 2 Month.
3. Giddiness since 5 yrs.
4. Headache with neck pain since 10 yrs.
1. Breathlessness since 4 years increased since 2 months.
- Onset- gradual
< Walking > Rest
< Exertion > Morning
> Sitting with support
< Night
< Stress > Sitting with leaning Back
2. Palpitaion since 2 month (Increased heart beat)
- Gradual
< Walking > Morning
< Ascending stairs > Sleep
< Swimming > Rest
< Afternoon 12.30- 3.00 pm > Sitting with support.
< Noise
3. Severe Giddiness since 5 yrs increased in last few months.
< Fasting > Rest
> Sleep
< Over Exertion > Lying down
< During coitus
< After coitus
4. Generalized Weakness since 3 yrs.
- Prostration
< Evening > Eating After
< 5 - 6.00 pm
< Fasting
- Weakness with trembling of Body.
5. Headache with Neck Pain since 10 yrs.
- Parietal region, nape of Neck, Frontal Region
- Character - Throbbing Pain
< Night > pulling hair
< Stress > Sleep
< Fasting > Pressure Hard
< Odour > Vomiting after
< Travelling
Past/History :-
Convulsion ? syncopal attack? in Feb (6 months before homoeopathic treatment)
Family/History :-
- Sister - Asthma Bronchitis
- Mother - Osteoarthritis
Physical General:-
Diet - Mixed
Appetite - Good, Cannot tolerate hunger
Desire - Non veg, Sweet + Tea, Milk Product.
Aversion - Pungent.
Food < - Non Veg
Tongue - Dry & Pale
Eye - Spec since last 5 Month.
Bowel - loose motions 3-4 times, Liquid stool,
Cramps in abdomen before stool.
Pungent, Toast, Oily Food.
Urine - Strong offensive, Frequency increased.
Back - Backache since 5yrs.
Dull aching pain
< Sitting Prolonged > Pressure
< Work > Massage
Skin - Papular acne on Scalp, Forehead.
< Non- Veg
< Oily Food
Perspiration - Scanty
Thermally - Chilly.
Sleep - Night- 9.30 pm – 7.00 am, Refreshing, Talking sometimes.
Dreams - Ghost, fright full.
Mind:-
Education - bachelors in electronics.
Occupation : Lecturer, but now left the job.
Tell me about your childhood?
I spent my childhood in village. We stayed as a Separate Family financial condition was average. I was good in studies. I liked company and was playfull. I had many friends and always liked company. I was mild, not very short tempered.
I shared good relations with my parents and siblings.
Tell me about your nature, tensions and stress ?
I am married since last 2 years. It was a love marriage and I faced lot of opposition from family for the same. It
was a stressful period. I share good relations with my wife but not very good with family(parents) even now I
stay as separate family with average financial condition.
Now a days I have increased temper tantrums may be due to health and stress at work. I have become less
expressive than before. I have no much desire to share my problems.
In past 1 year there was lot of stress in my work place. I suffered a lot in my college as HOD & Principle use to
trouble me for few issues. It was to the intensity that I had to leave the job & now searching for another. I had a
lot of anger for them.
At present I do have anxiety about the job.
Also I have no family support hence neglected Feeling from them.
As I have no job at present there is a financial insecurity lingering in mind. I also have a loan to be paid.
Any fears?
I have Fear of Darkness. I fear for future as my Concentration on work has reduced.
Totality:-
Anger suppressed
Dreams ghost ,frightful
Fearful
Forsaken feeling
Injustice intolerant
Loose motions oily fatty food agg.
Headache > vomiting.
Fasting agg.
Breathlessness with palpitation < afternoon.
Weakness < evening.
< night
< Exertion
Meat desire but agg.
< mental exertion.
< coitus during and after.
Chilly.
Response :-
Patient was admitted as the case needed a close continuous observation. Spigellia was administered. Initially in first 2 weeks no relief was noticed hence a change of medicine was done.
After changing the medicine in next 2 days patient had good improvement with complaint of migraine palpitations were reduced by 25 – 30%.
2D echo was repeated in next 20 days with showed improvement with reduced severity of gradation of mitral regurgitation.
Complaints recurred around one month later but with repetition of the medicine he settled in 2-3 days.
He was discharged in next few days……
A follow up was taken after 2 and ½ months where he had no complaints of dyspnoea, palpitations, sensitivity to noise and reports showed improvement of 50%. There was improvement in gradation of regurgitation..
He could exert and do work all day without any dyspnoea and palpitations which was not possible earlier. He could ascend stairs to 3 or 4th floor comfortably
No episode of headache since the homoeopathic treatment no episode of giddiness also.