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