cardiovascular system problems in gp

Cardio vascular Problems in GP

Cause of Angina Pectoris Presented By

• Prof.Dr.

• R.R.Deshpande

• 9226910630

7/24/2015 Prof.Dr.R.R.Deshpande 1

7/24/2015 Prof.Dr.R.R.Deshpande 2 7/24/2015 Prof.Dr.R.R.Deshpande 2

Cardio vascular Problems in GP

• Presented By –

• Prof.Dr.R.R.Deshpande (M.D in Ayurvdic

Medicine & M.D. in Ayurvedic Physiology)

• www.ayurvedicfriend.com

• Mobile – 922 68 10 630

• [email protected]

http://www.ayurvedicfriend.com/

mailto:[email protected]


GP problems of CVS

• 1) Acute chest Pain

•

• 2) hypertension

• 3) Palpitation

• 4) CCF


Acute chest Pain :

• Cardiac Pain

• a) IHD

• b) MI

• Non Cardiac pain

• a) Respiratory

• b) Oesophago – gastric

• c) Chest wall

• d) functional psychological (cardiac neurosis)

• Neurosis : like a Benign tumour of the mind.


Cardiac Pain :

• Chest pain = cardiac pain unless proved

otherwise

• Diagnosis is confirmed by ECG and other

symptoms

• Symptoms : retro sternal pain –

constricting pain shown by clenched fist.

• Cardiac Neurosis – Neurosis is like Benign

Tumor of mind


IHD : Ischaemic Heart Disease

• Causes :

• 1) Less O2 supply : Arteriosclerosis – arteries – layer means tunica intima are rough

• Atherosclerosis : Deposition of cholesterol on rough arteries.

• IHD is caused by less O2 supply or increased demand of O2 due to LVH in chronic hypertension or vascular spasm


Angina Pectoris

• 3 types according to duration and

intensity.

• 1) Stable or classical Angina

• 2) Unstable angina

• 3) M.I.

Angina cause

7/24/2015 8 Prof.Dr.R.R.Deshpande

Angina Pectoris


Stress Test



Stable angina Pectoris

• Due to transient ischaemia – caused by

vascular spasm – recovers by rest.

• Pain is lasts for maximum 2-5 mins.


Unstable Angina (Pre infarction)

• More severe, lasts longer

• Due to transient blood loss, fissuring and disruption of Atheromatous plaque, forming a thrombus.

• When Thrombolysis occurs, crisis ends.

• If thrombus not dissolve & coronary artery is occluded – Necrosis of cardiac tissues occurs then heart attack occurs (MI)


Stable or classical Angina

• i) Generally it occurs between age 50 – 60

years

• ii) Acute chest pain : radiating towards

• a) left shoulder b) Ulnar surface of hand

and arm c) back d) neck e) jaw



• Precipitating factors

• 1) Hurriedly climbing up steps

• 2) Heavy meal

• 3) Anxiety and stress

• 4) Straining for defecation

• 5) After sexual intercourse



• Treatment during attack

• Relieved by a) Complete rest – for 2-5

mins.

• Short acting Nitrates -- Glyceryl trinitrate –

(Angised) 0.5 mg or Isosorbide dinitrate 5

mg (Tab Sorbitrate) or Nitroglycerine spray

• Once the pain stops – spit or swallow tab

• Throbbing headache – side effect

Stable & Unstable Angina




• Nifedepine (Cap Depin)10 mg –

• bitten by the patient – releases the liquid (

absorbed sublingualy)


Atypical presentation of

Angina pectoris

• i) Anginal decubitus : This pain occurs at

night, when the patient is recumbent.

• ii) Varient Angino or Prinz metal's angina :

Chest pain at rest with palpitation and

breathlessness.


Atypical presentation of

Angina pectoris

• iii) Wenback's second wind Angina :

Pain starts white / after walking pain

stops spontaneously without

vasodialators.



• 1) ECG should be taken during exercise

called stress test or treadmill test.

• ST depression in lead II or V1 to V6.

suggests Ischaemia

• 2) 2D Echo : To see the how much

damage cardiac tissues. see the EF –

Ejection faction if it is less than 50 % then

suggest weak heart



• 3) Angiography : To see whatever the

damage is due to coronary artery block or

not and to see the which vessel block and

how many blocks are there.

• Angiograpy is imp. to know whether the

disease is

• 1) One vessel, 2) Two vessel 3) Three

vessel – Then CABG (Case is serious)


Prevention of Anginal Attacks :

• 1) Modification of life style :

• 2) Avoid the risk factors

• 3) Adequate rest

• 4) Proper exercises which will not

precipitate to M.I. (Breathing, yogic

exercises – best)


Prevention of Anginal Attacks

• 1) Planning and time table

• 2) Fatty food , high calorie diet, excessive

sweets, chocolates should be avoided

• 3) Rest – Rule of 8 -- 8 hours hobbies and

with family, 8 hours sleep & rest , 8 hours

for bread butter (job)


Prevention of Anginal Attacks

• Drugs :

• a) Nitrates

•

• b) blockers

•

• c) Ca antogonists

• d) Anti-platelet

Treatment of Angina



Nitrates : Coronary vaso-dialators

• 1) Glyceryl trinitrate – short acting (Tab

Angised ) or

• 2) Long acting Isosorbide Dinitrate –

(Isordil or sorbitrate ) 5 mg 8 hourly or

• 3) Isosorbide 5 mononitrate (Ismo 20 or

Monotrate 20 mg tds

• GIN – Glycerl trinitrate ointment or

Transdermal patches


-blockers

• Reduce the oxygen requirement of heart

by reducing HR & BP and myocardial

contractility.

•

• Atenelol – Tab Aten – 25-100 mg / day.OD

• Should be started along with Nitrates


Ca Antagonists

• This is powerful coronary and peripheral

vaso-dialator.

• Therefore give increase or adequate O2

supply and reduced O2 requirement.

• Blocks the entry of Ca into myocardial

cells.

• Therefore reduced the contractivity.


Ca Antagonists

No Name Dose

1 Nifedipine

(Cap Depin,Calcigard)

10 to 40 mg

TDS

2 Amlodipine(Tab Amlogard) 5– 10 mg OD

3 Verapramil(Tab Isoptin) 80-120 mg TDS

4 Diltiazem (Tab Dilzem) 30—90 mg TDS


Anti – Platelet

• Thrombus dissolving action.

• Aspirin – Acytel – calycitric acid – Its powerful

analgesic.

• Tab – Aspirin also known as 'Magic bullet' for

heart patient

• Doses – 100 – 150 mg/day.(Disprin)

• Inhibit the aggregation of platelets.

• Cheap & proved effective

• Well understood side effect profile.


Anti – Platelet -- Contraindication

• 1) In peptic ulcer & 2) Hypersensitivity patients.

• For this patients

• 1) Tyclopidine 250 mg – BD (Tab – Tyklid)

• Side effects : effect starts after 5 days.

• Neutropenia – So Adv Haemogram per week.

• 2) Clopidogrel – (Tab – clopiget) 350 mg – stat & 75 mg BD.

Ayurvedic Advice for Angina

• Rule out the cause and treat accordingly e.g. anemia,

syphilis, hyper thyroidism, paroxysmal tachycardia.

• Advise obese to reduce weight.

• Keep away from bad habits like smoking, alcohol,

tobacco,excessive coffee or tea etc.

• Control diabetes and hypertension with proper

medication.

• Do not exert too much. Have enough rest


Ayurvedic Advice for Angina

• Do not suppress or force natural urges like

urine and stool.

• Regular bowel movements.

• Avoid over indulgence of sex.

• Avoid excessive sweat, sour and salty

food.


Ayurvedic Medicines

for stable Angina • Bruhat Vatachintamani 30-60 mg. with

ginger juice.

• Harinshrung Bhasma 175 mg. +

Laxmivilas 50 mg. with ginger juice


Prevention of progress

of Angina • For prevention use following for 3 months

• Makardhwaja 60 mg. + Shrung Bhasma

125 mg. each morning and

Mahalaxmivilas 125 mg. + Sitopaladi

Churna 750 mg. afternoon and night.



Unstable Angina or

Pre Infarction Syndrome

• Known case of stable Angina – In this case if

• 1) Pain more severe, last longer, occur with

increasing frequency.

• 2) Pain occurs at rest kin known case of stable

Angina.

• 3) Pain associated with vomiting, dyspnoea &

perspirations.

• 4) Pain not relieved completely by sublingual

nitrates.


Unstable Angina or


• Diagnosis : Transient ECG changes – This are

'ST" elevation / depression and 'T' Inversion.

• Changes revert back to normal in 24 hours.

• Since No necrosis

• Suspect MI when ?

• 1) ECG changes no revert back in 24 hours.

• Cardiac enzymes levels are increased


Unstable Angina or


• For the Heparinization admit the patient.

Its also called – Thrombolytic Therapy.

• Give Inj – Streptokinase (I/V) or

Urokinase

Coronary Arteries 2



Acute M.I.

• Symptoms : 1) Severe retrosternal constricting

chest pain – radiating.

• Infrascapular (back pain)

• Left shoulder, jaw, neck & epigastrium

• Vomitting / Nausea

• Profused sweating

• Incontinance of urine or stool

• (Complete rest even – bed pan gives on bed)


Acute M.I.

• Sympathetic stimulation ---

• Tachycardia, palpitation, restlessness,

sweating.

• Parasympathetic stimulation ---

• Bradycardia and hypotension


Atypical M.I. or Silent Inforct

• 1) No pain in long standing DM, HT, elderly or

middle aged post-operative patient.

• 2) Sudden sweating and vomiting, with or

without chest pain.

• 3) Sudden breathlessness with or without chest

pain.

• 4) Acute confusion , severe unexplained,

weakness, arrhythmia, syncope, sudden death


How you can diagnose

the pain of M.I. ?

• Patient is restless

• Moving on bed.

• Profuse sweating, cold extrimities.

• Anxious, pale – Face

• Pulse – Brady or Trachy or Normal

• B. P. -- Hypo or Hyper or normal


Acute M.I.

• If there is doubt then repeat the ECG.

• RS – Brasal creptitions

• ECG – i) ST elevation, but

• ii) After 24 hours – 'T' inversion

Types of MI


MI


Area of Infarct


MI – ST Elevation


Area of Infarct Table



Acute M.I. -- Blood investigations

• 1) CPK – MB

• 2) SGOT

• 3) LDH

• 4) Cardiac Froponin – T (with 5 hours) costly but confirmatory.

• 5) Sr. Myoglobin – very sure if it is positive.

• Above all enzymes are in the enzymes come from cardiac necrosed tissue. In blood this enzymes level increases.

• When there is muscle degeneration when level of SGOT is increased.


Acute M.I. --Before hospitalization :

• 1) Sublingual – Tab Angised 0.5 mg or Tab Sorbitrate 5 mg.

• 2) To dissolve the thrombus– Disprin 100 – 150 mg.

• 3) For severe pain – Inj. Fortwin – 30 mg I/M

• 4) When bradycardia due to cardiac shock then gives Inj – Atropin 0.3 to 0.6 mg I/V

• 5) In known patient of LVH gives – Inj – Lasix 20 – 80 mg I/V diuretics)

• If B.P. falls down rapidly -- Shift the patient immediately in the hospital

ECG Waves


ECG Changes in MI


Ayurvedic Medicines after Acute

attack of MI • For stable patients : Use following medicines

• (1) Bruhatvatachintamani Rasa 1 Tab. 2 times a day.

• (2) Shrungabhasma 250 mg. 3 times a day.

• (3) Vatavidhvansa Rasa 2 Tab. 3 times a day.

• (4) Khurasanai Ova 100 mg. 3 times a day.

• (5) Prasham 4 tablespoon with equal amount of water at

bed

• time.

• (6) Triphala Churna 1 tablespoon with warm water at bed

time.


Prevention of further

Heart Attack • 1) Suvarnabhasma 6 mg. + Makardhwaja

50 mg. + Shrungabhasma 250 mg. 2 times

a day with honey. Or

• 2) Hrudayanarva Rasa (B) 1 Tab. 2 times

a day +Nagarjunabhra Rasa 2 Tab. 3

times a day + Yakuti Rasa 2 Tab. 3 times

a day+ Prabhakar Vati 2 Tab. 3 times a

day.



Hypertension

• Mild – 90 – 110 mm of Hg.

• Moderate – 110 – 130 mm of Hg

• Severe - > 130 mm of Hg

Rheumatic Mitral Stenosis


Dial BP Apparatus –

Visiting Bag


Damage by Hypertension



Hypertension

• 1) Most of the hypertension is Idiopathic.

• 2) Secondary Hypertension – Renal RFT

• Hepatic – USG, LFT

• adv. 2D Echocardiogram – Cardiac – Valvular

defect

• Acc. to symptoms – hormonal (T3, T4, T3H etc)

• RFT – Renal Function Test -- Urea, Creatinine

• In every Hypertension patient adv. – USG of

abdomen and some time Renal angiography

Hypertensive Heart



Hypertension -- Treatment

• Mild hypertension – No Drug treatment.

• Life style management – Planning, time management.

• Reduced stress – Meditation, Yoga, Pranayam

• Restriction of Salt, pickle, papad, fast food, and preservative foods, wafers all are restricted.


• Deep fried food are avoided and unsaturated oil use e.g. sunflower oil

• Regular walking – Collateral circulation are develops.

• Reduced weight if high weighs.

• Stops alcohols, tobacco, cigars etc




• Monodrug Therapy 1) - Blockers

• Tab – Aten – 25 – 50 mg & 100 mg – 1 – 0

– 0

• 2) Ca – channel blocker

• Tab – Stamlo 2.5, 5 mg – 1 – 0 – 0

• 3) ACE – Inhibitor Tab – Enam – 5 to 10

mg.


Moderate Hypertension --

Treatment

• Mono drug – Maximum dose or Combination

treatment

• Either - Blocker + Ca chanel blocker or

(minimum dose) - Blocker + ACE inhibitor

• Compliance of patient is very imp. + Diuretic –

Lasix 40 mg 1 OD.

Moderate Hypertension --

Treatment • Kesol – To avoid lasix's side effect

• Diuretic drugs – Potassium sparing

diuretics

• Tab- Biduret, Tab – Lasilactone -

diurectics



Severe Hypertension

• Malignant H. T.

• Medical Emergency

• Admit instant -- Treatment is of hospital level

• Symptoms :

• 1) Severe Headache

• 2) Vomiting

• 3) Visual

• 4) Convulsions, paralysis (transient)

• 5) Coma


Accelerated H. T.

• Medical urgency

• At level of G.P. (No serious complaint of patient)

• Diastolic > 130 , but without symptoms like in Malignant HT, which you can treat primarilty

• Cap – Depin – 5 mg gives sublingulal, repeat after 10 mins, till the B.P. comes to 110.


Accelerated H. T.

• Then cap – Depin 10 mg TDS (1 – 1 – 1)

• Tab Aten – 50 mg BD

• Tab- Lasix – 40 mg BD

• If the BP doesn’t come down 110 within 24

hours then admit the patient.

Ayurvedic Medicines for

Hypertension • Hypertension ( Pitta avruta vata) –

• Duralabhadi ( Dhamasa) Kadha -- 4 tsf

with equal amount of water BD

•


Ayurveda for Mild Hypertension

• Diastolic less than 90 mm of Hg

• (i) Siledin ( Alarsin ) 2 Tab. 3 times a day.

• (ii) Sapera forte (charak ) 2 tab. at bed

time.


Ayurveda for

Moderate Hypertension • Diastolic in-between 90-100 mm of Hg

• (i) Abana 2 Tab. 3 times a day. And

• (ii) Punanarnavasava 4 tablespoon with

equal amount of water 2 times after meals.


Ayurveda for

Severe Hypertension • Diastolic more than 100 mm of Hg

• Suvarna Sutshekhar 30 mg with honey every 5 minutes.

• Rasagandha (AYR) 2 Tab. 3 times a day.

• Sutshekhar Rasa sadha 2 Tab. 3 times a day.

• Arogyavardhini 2 Tab. 3 times a day.

• Duralabhadi kwath 4 tablespoon with equal water 2

• times after meals.


Ayurveda for

Severe Hypertension • Diastolic more than 100 mm of Hg

• Arogyavardhini 2 Tab. 3 times a day.

• Gokshuradi Guggulu 2 Tab. 3 times a day.

• Rasayana Churna (HP) 1 tablespoon 2

times a day.

• Siledin (A) 2 Tab. at bed time


Vaman – Useful to reduce Cholesterol

• High Cholesterol like above 300 mg % -- cause

Atherosclerosis – leads to Hypertension

• Diet control + Lovastatin like medicines can reduce

cholesterol very slowly like 20 mg in 6 months

• But Vaman ( Therapetic Vomition ) with prior Snehapan

with Tiktak Ghee 50 mg daily + Fomentation ,can show

magic results for reducing Blood Cholesterol level +

Internally

• Tab Arogyavardhini 3 TDS + Tab Triphala 1 TDS +

Nagarmotha & Vidanga churna each 3 Gm TDS



Palpitation

• 1) Cardiac – Paroxysmal ventricular

Tachyeardia or Extrasyslole (Take history)

• 2) Non cardiac – i) Hyperthyroidism ii)

Hypoglycemia

• 3) Functional – Cardiac Neurosis

(Psychological)

Pulse Examination


Heart Palpitation



Palpitation

• Tab – Ativan (Lorazepam) – 1 mg stat –

BD for 4 days

• Tab – Inderal – 10 – 40 mg TDS

• Also a anti anxiety or anti stress drug.

Therefore Anti Arrythmic (acts physically

and mentally also)


Hyper & Hypoglycemia

• Diabetic ketoacidosis – Hyper glycemia (fruity odour)

• Hypoglycemia is always fatal because brain can dead within 2 min if less or no supply of glucose.

• Insulin dependent patient ,if do fasting.

• Profuse sweating and acute incidence.

• Give the I/V glucose – 25 %


CCF – Congestive Cardiac Failure

or Cardiac Asthma

• LVF (Left Ventricular Failure)

• RVF (Right Ventricular Failure)

• Cardiac Asthma is the breathlessness ,

during CCF.

Symptoms of CCF


Symptoms of CCF 2



CCF

• Treatment At GP level

• 1) Bed rest completely

• 2) Salt free diet (because of salf is hygroscopic nature)

• 3) Fluid intake restricted (Inj. Lasix – 40 mg stat. or tab lasix – 40 mg BD)

CCF

• liq. Kesol – 1 TSF – TDS with glass of water.

• or pattasium soarina diuretics are used such as

• Tab Amifru – 1 – OD or

• Tab Lasilactone – 1 – OD



CCF

• For the heart :

• Lanoxin – 0.25 mg 1 OD for 6 days (Sunday off)

• Inj – Aminophylline 10 ml diluted in 20 ml of 25 % dextrose.

• This inj.-- give very very slow (for 30 ml – 10 min)

Congestive Heart Failure



CCF

• B.P. control – Tab Enam 2.5 mg BD (Enalapril)

• Infection – control by Cap – Ampiclox – 50 mg TDS

• If till there is no control then give adv. for Hospitalisation

Ayurvedic Medicines for CCF

• Shrungbhasma 2 Tab. 3 times a day.

• Vishatindookvati 1 Tab. 3 times a day.

• Punarnavasava 4 tablespoon with equal

amount of water 2 times after meals.


Ayurvedic Cardiac Tonic

• 1) Arjunarishta(Parthadyarishta) -- 4tsf

with equal amount of water BD in CCF

• 2) Arjun Kshirpak --- 50 ml BD in patients

of Angina Pectoris


X ray of CCF


Shock ,Pulse less patient

• Shock,Pulse less patient ----

• In Emergency Life saving drugs in

Ayurveda –

• Tab Laxmi vilas rasa

• Hemagarbha Chatan or licking


Conducting system of Heart


Ayurved & Yoga – Good help for Heart Patients

• Ayurvedic Internal Medicines

• Ayurvedic Detox Therapies or Panchakarma &

allied procedures

• Yoga Asanas

• Pranayam

• Meditation

• Everything can be helpful for Heart patients ,but

always under guidance of Expert


Abhyanga

• Gentle ,soft Full body

massage helps to

improves Blood

circulation, Providing

good nutrients to

cells, remove the

waste products

efficiently

• Soothening to body &

Mind


Shirodhara –

Beneficial to reduce Blood pressure

• Oil shower on head

controls hyper activity

of sympathetic

system

• Reduces stress

• Cool down irritability

of mind

• Produce sound sleep


Hrud Basti – Heart Tonic

• Improves tone of

Cardiac muscle

• Improves elasticity of

vessels

• Very Good Analgesic

& Anti-inflammatory

action

• Reduces Anginal pain


Raktamokshan or Blood letting –

Good to reduce Hypertension

• Reduces blood

volume

• Reduces cardiac load

• Stimulation for proper

blood circulation

• Removes Impurities

or Ama or Endo

toxins from blood


Pranayam –Deep breathing Practice

• Proper perfusion of

Oxygen

• More Energy to

cardiac muscle

• Heart function

improves


Meditation – Best Relaxation

• Best way for

maintaining

Homeostasis

• Physical Rest

• Mental Tranquility


Yoga Postures for Heart Patients



Ayurved for General Practioner

• Very very popular

Book in Medical

Practioners

• 100 common

symptoms of General

Practice with

causes,Investigations

& Ayurvedic

Treatments


Clinical Examination

• Systemic Examination

of 8 systems

• Ayurvedic Srotas

Examination

• Clinical significance of

Lab Tests &

Radiology,USG,2D

Echo


Notes on Medicine Part 1

• Very very useful Book

for all Medical

Practioners

• Guidelines with

causes,symptoms,Ay

urvedic & Modern

Treatments to treat

Fever,Pain in

Abdomen & Arthritis


Best Book for

Medical Students & Practioners

Preventive Cardiology

& Ayurvedic Management

• Best Book for GP

• All cardiac problems

like

Hypertention,CCF,

Angina,Myocardial

Infarct are discussed

with Ayurvedic

Management

Contact -922 68 10 630


Digestive Problems

& Ayurvedic Management


• All Digestive

problems like

Acidity,Pain in

abdomen,

• Constipation ,colitis

are discussed with

Ayurvedic

Management

Contact -922 68 10 630


Gynaecological Problems &

Ayurvedic Management


• All Gynaecological

problems like Heavy

bleeding,White

discharge,Infertility,ca

ncer are discussed

with Ayurvedic

Management

Contact -922 68 10 630


Arthritis,Backache &

Ayurvedic Management


• All Joint problems

like Rheumatoid

Arthritis,Osteoarthritis

,Backache are

discussed with

Ayurvedic

Management

Contact -922 68 10 630


Neurological Problems & Ayurvedic

Management


• All Neurological

problems like

Headache,Epilepsy,Al

zeimer’s Disease are

discussed with

Ayurvedic

Management

Contact -922 68 10 630


Ayurvedic Concept of Diet

& Nutrition


• Dietary Advice

according to Prakruti

,Dietary prescriptions

for many diseases are

given

• Contact -922 68 10

630


Health Tips for 365 Days


• This Book is very

useful from Common

man to Doctors

• It covers all imp

aspects mentioned in

Ayurveda

• Open as per date &

complete reading of

one page only

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• Sharing of Knowledge

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cardiovascular system problems in gp

Education

cardiac pain

stable angina pectoris

stable unstable angina

angina cause

acute chest pain

classical angina treatment

gp cause of angina pectoris

unstable angina pre