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