Transcript Slide 1

N3
Name: AA
60 yrs. Male
Architect
K/C/O: I.H.D, H.T & D.M
C/O: Sudden CHEST PAIN with perspiration & Dyspnoea
2nd episode since last 6 months
Diagnosed as A.M.I. WITH C.C.F. WITH ARRYTHMIA
All cardiac enzymes increased
ECG showing global infarct Atrial fibrilation
Ejection fraction 20%
Hb – 8.9mgm %
P.A.P. – 40
B.P: 100 systolic:
H.R 150/min
ANGIOGRAPHY
shows
TRIPLE
VESSEL
disease.
Kellipies classification Gr. IV survival chances around 10%
Rx. Given
POOR RESPONSE TO THROMBOLYTICS
MYOCARDIAL DEPRESSION AND CARDIO GENIC 
SHOCK
ALREADY ON NITROGLYCERINE & ANTIARYTHMIC
AGENTS  IN ADEQUATE RESPONSE
LAST RESORT INTRAAORTIC BALLOON PUMP FOR
MAINTAINING THE CORONARY FLOW AS WELL AS
PRESSURE
STILL KEEPS GETTING ANGINA AND ARRYTHMIAS
General condition  Exhausted & V. Poor
Cardiac Surgeon refuses to take him on table.
BEHAVIOUR DURING ANGIOGRAPHY
♠
CHILD LIKE BEHAVIOUR
♠
EXTREMELY UN COOPERATIVE
♠
ANXIETY3 & FEAR3 OF DEATH
♠
CONSTANTLY ASKING WHETHER
EVERYTHING WOULD BE OK
♠
DUE TO ANXIETY THERE WAS ACUTE
ANGIOSPASM WHICH WAS DEMONSTRATED
IN ANGIOGRAPHY
♠
REFUSED ANGIOPLASTY ON THE TABLE AND
HAD TO BE TAKEN BACK TO ICCU
INTERACTION WITH PATIENT IN I.C.C.U
§
Cardiac Status Same
§
Talks to physician about resuming work  “Nothing
has happened to me”
§
Denies fears & says nothing is wrong with me and then
suddenly says that “My mother died on the opposite
table in the same hospital”
§
Never removes the left hand from the heart
§
Lt. chest pain with back pain
§
Constantly denies anxiety and fear of death but wants
you to be near and never leave him alone.
§
Feels unsafe in hands of doctors and not sure whether
they will be able to handle him
Observation: Flat expressionless depressed face with fear
struck eyes exhausted look
BACK GROUND

Extremely conscientious (Russian Conscience)

Meticulous (British Meticulousness)

Cautious (American cautiousness)

Hardworking self made man

Conflict with father  Left house

Conflict with only son  Staying separate

Sharp and critical in judgment

Always pushes himself hard than what he can do

Indian by sentiments and relationships 

Always wanting to help the good cause in his own way

Virgin track record  fears blemishes
CURRENT TOTALITY
 FEAR OF DEATH HEART SYMPTOMS DURING
 FEAR FAILURE OF
 SELF DECEPTION
 OCCUPATION DESIRE FOR
 MISTRUST ON SURROUNDING  THINKS THEY
WILL HARM HIM
 HOLDS HAND OVER HEART
 DEVELOPED MURMER  AS CORDEA
TENDINEA WERE FIRED
Remedy : NAJA 200C
• A single dose of Naja 200C resolves the
arrhythmia, blood pressure improves and
pulmonary arterial pressure improved
• Patient taken up for Cardiac Bypass surgery
• Post-surgery, one more episode of
arrhythmia with fall in blood pressure not
responding to conventional drugs, Surgeon
repeats one dose of Naja 200C
After recovery from surgery, chronic
treatment continued.
• AURUM ARS is the indicated chronic
constitutional remedy
• Low to moderate susceptibility
indicated a 30C in infrequent doses
• Patient improves to such an extent that
he now attends work regularly and
travels alone frequently.
NAJA expression in Cardiac Conditions:
LOCATION:

HEART

BLOOD VESSELS

VALVES

NERVES
PATHOLOGY:

ISCHEMIA & NECROSIS OF MYOCARDIUM

MYOCARDIAL DEPRESSION
A/F: ILL EFFECTS OF GRIEF
- ANTICIPATION
General Sensation
Sharp Neuralgic Radiations
Constricted Feeling
Drawn up feeling
Intense burning
Exhausted – as if
intoxicated
Screwed up Sensation
Severe pain v/s Insensibility
Modalities:
< Lying on Lt. side
< After sleep
< After Menses
< Cold Draft
< Alcohol
> Smoking
> Riding
Location & Organs
Nerves – Heart
(Mitral Valve) –
Respiration &
Throat
Cerebellum Medulla
Myocardium, Blood
vessels Lt. sided,
Head and ovaries
Pathogenesis
Ischemia – Infarct
Oedema – Hyertrophy
Failure, Collapse,
Arrythmia,
Sepsis of Vital organs
Irritation/Inflammation
Nerves
Clinical Conditions
Cardiogenic
Angina pectorls
ShockHeadache
Cardiac Failure
Ovarian Neuralgia
RHD
Intercostal Neuralgia
Cardiac Arrythmia