Bharatesh Homeopathic Medical College and Hospitals

BHARATESH HOMEOPATHIC MEDICAL COLLEGE AND HOSPITALS,

POSTGRADUATE RESEARCHCENTRE,

BELGAUM-590016.

KARNATAKA.

Recognised by

CENTRAL COUNCIL OF HOMEOPATHY, NEW DELHI.

Affiliated to

RAJIV GHANDHIUNIVERSITY OF HEALTH SCIENCES, BANGALORE.

SYNOPSIS

MD (HOMOEOPATHY)

A CLINICAL STUDY OF CORONARY ARTERY DISEASE AND ITS HOMEOPATHIC MANAGEMENT ON REPERTORIAL BASIS

Dr. Nazima Khan.

Under the Guidance of

Dr. Dhanashri. H. Ajgaonkar MD.(HOM)

Guide, H.O.D., Professor of Repertory,

Bharatesh Homeopathic MedicalCollege and

Hospital, P. G. Research Centre, Belgaum.

From,

Dr. Nazima Khan.

To,

Dr. Dhanashri. H. Ajgaonkar MD.(HOM)

Guide, H.O.D., Professor of Repertory,

Bharatesh Homeopathic Medical College and Hospital, Belgaum.

Sub:- Application to accept my synopsis for the dissertation.

Respected Madam,

I Dr. Nazima Khan. would like to forward my application for the approval of my synopsis under your guidance for the following topic, "A CLINICAL STUDY OF CORONARY ARTERY DISEASE AND ITS HOMEOPATHIC MANAGEMENT ON REPERTORIAL BASIS"

Hope you will approve the same.

Thanking you

Date: 02-06-2008

Place: Belgaum Yours Sincerely

Dr. Nazima Khan

Department of Repertory

Bharatesh Homeopathic MedicalCollege,

Belgaum.

From,

Dr. Dhanashri. H. Ajgaonkar MD.(HOM)

Guide, H.O.D., Professor of Repertory,

Bharatesh Homeopathic MedicalCollege and Hospital, Belgaum.

To,

Dr. Nazima Khan.

Sub: Acceptance of synopsis for the dissertation.

Dear Doctor,

I have accepted your topic "A CLINICAL STUDY OF CORONARY ARTERY DISEASE AND ITS HOMEOPATHIC MANAGEMENT ON REPERTORIAL BASIS" for the dissertation. Your synopsis will be forwarded to RGUHS.

Date: 02-06-2008

Place: Belgaum.

Dr. Dhanashri. H. Ajgaonkar MD.(HOM)

Guide, H.O.D., Professor of Repertory,

Bharatesh Homeopathic MedicalCollege

Hospital, Belgaum.

RAJIV GHANDHI UNIVERSITY OF HEALTH SCIENCES, KARNATAKA, BANGALORE.

ANNEXURE II

APPLICATION FOR REGISTRATION OF SUBJECT FOR

DISSERTATION

1. / NAME OF THE CANDIDATE AND ADDRESS / Dr. NAZIMA KHAN
DEPARTMENT OF REPERTORY,
BHARATESH HOMEOPATHIC MEDICALCOLLEGE & HOSPITAL, BELGAUM-16
PERMANENT ADDRESS / PLOT NO. 77, SARTHI NAGAR, BAUXITE ROAD, SAHYADRI NAGAR, BELGAUM-591108.
2. / NAME OF INSTITUTION / BHARATESH HOMEOPATHIC MEDICAL COLLEGE & HOSPITAL, BELGAUM-16
3. / COURSE OF THE STUFY & SUBJECT / DOCTOR OF MEDICINE
(HOMOEOPATHIC) REPERTORY
4. / DATE OF ADMISSION TO COURSE / 02/06/2006
5. / TITLE OF THE TOPIC / "A CLINICAL STUDY OF CORONARY ARTERY DISEASE AND ITS HOMEOPATHIC MANAGEMENT ON REPERTORIAL BASIS"
6. / BRIEF RESUME OF INTENDED WORK
6.1 NEED FOR THE STUDY:
Coronary Artery Disease (CAD) the leading cause of morbidity and mortality through out the globe including our country. CAD is the greatest scourage affecting the industrialized nations. There is been alarming prevalence of CAD precipitated by an epidemic of obesity, diabetes, Hypertension, tobacco faulty life style etc.
CAD is a major cause of preventive morbidity and premature mortality. Pharmacological approach plays important in curbing the growing menace of CAD and also contributes towards better arrival of life. Major chunk of patients of CAD in todays seneroid are Diabetes, Hypertension, Heart failure, Cardiac Arrhythmias and so on.
Null Hypothesis:
Cases treated on constitution bases may fail in the treatment of Coronary Artery Diseases.
6.2 REVIEW OF LITERATURE:
Coronary Artery Disease in the most common type of heart disease. It’s the trading cause of death in India and other Asian countries for both men and women.
CAD is a condition in which plague builds up inside the Coronary Arteries. These arteries apply heart muscles with oxygen rich blood. Plague is made up of fat, cholesterol, calcium and other substances found in the blood. As this material builds up the blood paths flowing into and out of the heart muscles gets smaller and decrease the blood flow. It a blood clot plugs one of these arteries of blood flow decreases enough, the heart muscle – starved for oxygen dies and a heart attack occurs.
CAD often progresses slowly for decades and becomes serious only in older age, but it can develop rapidly in younger people. Men have a higher risk of developing CAD at younger ages; but young women can also develop CAD After menopause, the like hood of CAD and heart attacks in women significantly increases. 1
Cause:
CAD thought to begin with damage or injury to the inner layer of coronary artery. The damage may be caused by various factors including.

Smoking.
High blood pressure.
High Cholesterol.
Diabetes.
Radiation therapy to the chest, as used for certain types of cancer.

Risk factors.

Age
Gender
Family History
High stress

Smoking
High blood pressure
High blood cholesterol levels
Physical Inactivity

Diabetes
Obesity

Risk factors often occurs in clusters and may build on one another, such as obesity leading to diabetes and high blood pressure. When grouped together, certain risk factors put you at an ever greater risk of CAD.
For e.g. metabolic syndrome a cluster of conditions that includes elevated Blood pressure, high triglycerides elevated insulin lends and excess body fat around the waist – increases the risk of CAD.
Sometimes CAD develops without any classic risk factors, other possible factors including

C-reactive
Homocystine.
Fibrinogen
Lipo proteins (a)2

Patient Presentation:

CAD causes symptoms in some people or it may be discovered during routine examination due to high blood pressure or cholesterol test results.
May be asymptomatic, especially in diabetic women and the elderly.
Chest pain is the most common symptom.
Pain is often characterized as "crushing" or "pressure".
Dyspnoea.
Associated symptoms includes nausea, vomiting, diaphoresis light-headedness or fatigue.
Hypertension or Hypotension.
Dysrhythmias may occur.

Diagnostic Evaluations:

History is an important component in the evaluation for CAD.
EKG/ECG
Echocardiography
Stress test.
Coronary angiography.
Blood Investigation .3

Treatment: In majority of the patient all that is needed is simple assurance and explanation about the nature of decrease and Advice Risk factor modification is a important initial component of treatment, including diet, exercise, smoking cessation, strict control of diabetes, hypertension and treatment of hyperlipidemia.
Some Rubrics found in Dr. J.T. Kents Repertory
Section – Chest
Rubric - Anxiety
Subrubric – Heart
Section – Chest
Rubric – Constrictions
Subrubric – band as from
Some Rubrics from Robin Murphy's Repertory
Section – Disease
Rubric – Angina
Section - Disease
Rubric – Arteriosclerosis
Section – Heart
Rubric – apprehension
Section - Heart
Rubric – Fullness
Subrubric – Painful
Section – Chest 6
Subsection – Heart and Region of
Rubric – Pressing
Homeopathic Management:
Accuracy and efficiency in homeopathic therapeutics is only possible to those who have a clearly defined idea of the field in which the principle of similar in operations. 7
Most of the drugs found useful in angina/ Coronary Artery disease under on the basis of the person constitution including their profession, physical and mental state.
Cactus g Q, Latrodectus, Digitalis, Lachasis, Ars Alb, Terminalia.8
Sulp, Phos
E.g. Digitalis.
Physio logical action.
Two principle Action – Toni cardiac and Secondary diuretic
(a) Toni cardiac:Digitalis in a sufficient dose cause bradycanida. It acts on the Bundle of his and on the pneumogastric (inter and extra cardiac action) nerve. The second important fact about Digitalis is that it prolongs diastole. Thus myocardia has more time to rest between the systole the ventricles are filled up and are emptied completely and if there is arrhythmia the rhythm is regularized.
(b) Diuretic action: It is a result of the Toni cardiac action of the remedy. However it has a diuretic action on the kidney by causing slight vaso – dilatation. 9
Miasmatic Diagnosis:1) According to Dr. Subrata Banerjea.
Psoric heart:All the heart complaints including cardiac pain and angina areaggravated in the evening, movement, from cough, laughing after make any attempt at movement.
Amelioration – By Rest
Brady cardiac, rube is full bounding, cyanosis in marked.
Sycotic Heart – Aggravation from heat change of weather.
Amelioration – Gentle exercise and all sorts of Abnormal discharge.
-Dyspnoea and Tachycardiac is present
-Pulse is slow and feeble.
Syphilitic heart:Aggravation – night, sunset, perspiration and movement.
Amelioration – during day, change of position and cold in general.
- Pulse – Irregularity.
Tubercular Heart:Aggravation by high attitudes cannot climb stairs or ascend hills and night Aggravation Amelioration – By lying down and in open air. Palpitation is marked and is accompanied by fainting, temporary loss of vision, pallor great weakness is also present.
Pulse is feeble thread like quick pulse. Dyspnoea is often painful along with persistent emaciation. 10
According to J.H. Allen.
Psora:Is nothing but organic or functional disturbance symptom includes weakness, goners, fullness and heaviness are present violent palpitation and sensation of band about the heart is marked. More or less anxiety and more or less fear is also present along with painful dyspnoea.
Sycasio/Syphilitic  Its nothing but d-generative changes are found, very little mental disturbance. Heart trouble for years. Throbbing with oppression along with Dyspnoea is present.
Tubercular:Rush of blood to the chest, fullness and violent palpitation is marked symptom in tubercular miasma, accompanied with fainting, temporary loss of mission, pallor and great weakness is above present.11
According Phyllis spright
Psora:great weakness fullness heaviness and violent palpitation is marked associated with gastric disturbance Anxiety fear in heart decrease and mental distress. Heart affection from fear disappointment, loss of friend or over joy. Patient think of heart trouble and are going to die. Dyspnoea painful.
Pseudo Psora:Rush of blood to the chest especially youngers, accompanied with fainting temporary loss of vision, pallor, great and weakness. Aggravated by climbing.
Syphilis / Sycosis
Very little mental disturbance is present. They have heart trouble years ago, they die suddenly without warning.
Patient usually or they all usually unaware of it.
Fluttering / oppression and difficult breathing is marked. 12
Complications:
CAD can had to

Chest pain (Angier)
Heart Attack
Heart Failure
Arrhythmia

7.
8. / 6.3OBJECTIVES OF THE STUDY:
1) To study the clinical presentation of CAD.
2) To study the application of various repertories in the treatment of CAD
3) To Assess the role of constitutional remedies in the treatment of CAD and its miasmatic cleavage.
MATERIAL AND METHODS:
7.1 SOURCE OF DATA:
Patient with clinical manifestation of CAD will be collected from
1) I.P.D., O.P.D., Peripheral Clinics of Bharatesh Homeopathic MedicalCollege and Hospital, Belgaum.
2) Balaji Hospital and heart Cam Center, Belgaum.
7.2 METHOD OF COLLECTION OF DATA:
(Including sampling procedure if any)
Patient will be selected on the basis of inclusion, criteria, history and findings. Detailed case history will be taken by interview as per the pro-forma a prepared. Every case will be followed for a period of minimum 9 months.
Follow up:As per the requirement of the case.
Sampling size:Minimum 30 in number Both sex.
No particular sampling procedure shall be adopted.
The duration is from 2008-2011
Inclusion Criteria:

All the patients who all in the age group above 30 years.
All the clinically diagnosed case of CAD patient irrespective of their sex, socio economic status ethnic group and occupation will be considered.

Exclusion Criteria:

Immuno compromised individuals.
Any gross pathological changes with complications with irreversible pathological changes.
Complicated congenital heart diseases
Purely surgical.

Results:

Recovered.
Improved
Not improved

7.3 DOES THE STUDY REQUIRE ANY INVESTIGATION OR INTERVENTION TO BE CONDUCTED ON THE PATIENTS OR OTHER HUMAN BEINGS OR ANIMALS? IF SO, PLEASE MENTION BRIEFLY.
The study needs routine as well as specific investigations.
7.4 HAS ETHICAL CLEARANCE BEEN OBTAINED FROM YOUR INSTITUTION IN CASE OF 7.3?
Yes. Ethical clearance has been obtained from the institution.
LIST OF REFERENCES:
1) on 28/10/2008
2)Braun world's Heart Disease A text book of Cardio vascular Medicine Indian Edition 7th Edition; 940-952PP
3)IN A PAGE Cardiology by Rajnish Prasad, Scott Kahan Wolters Kluwer / Lippincott williom and wilkims; 12 pp
4)Kent J. T. Repertory of the Homeopathic Materia Medica 6th edition New Delhi B. Jain Publishers Pvt. Ltd ; 822 pp, 826pp
5)Homeopathic Medical Repertory, A Modern Alphabetical Repertory by Robin Murphy MD IBPP Publishers. ; 884;885;1015;1019pp
6)Boenninghausen's Characteristics Materia Medica and Repertory New Delhi, B Jain Publications Pvt. Ltd; 775pp
7)Stuart close the Genius of Homeopathy, Lecture and essays on Homeopathic philosophy B. Jain publishers Pvt. Ltd ; 36pp
8)Homeopathy the complete hand book by Dr. K.P.S. Dhama and Dr. (Mrs.) Suman Dhama ; 28pp
9)Fortier – Bernoville Remedies of the circulatory and Respiratory system 2nd Revised Edition ; 4;35pp
10)Miasmatic Diagnosis Practical Tips with clinical comparison Dr. Subrata Kumar Banerjea ; 55pp
11)The Chronic Miasms J.H. Allen ; 222 ;223; 225pp
12)A comparison of chronic miasm Phyllis speight Jain Publishing co New Delhi ; 52; 53 pp
9. / SIGNATURE OF THE CANDIDATE
10. / REMARKS OF THE GUIDE
11. / NAME AND DESIGNATION OF
11.1 GUIDE / DR. D.H.AJGAONKAR MD.(HOM)
GUIDE, H.O.D., PROFESSOR OF REPERTORY,
BHARATESH HOMEOPATHIC MEDICALCOLLEGE AND HOSPITAL, BELGAUM.
11.2 SIGNATURE
11.3. CO-GUIDE (IF ANY)
11.4 SIGNATURE
11.5 HEAD OF THE DEPARTMENT / DR. D.H.AJGAONKAR MD.(HOM)
GUIDE, H.O.D., PROFESSOR OF REPERTORY,
BHARATESH HOMEOPATHIC MEDICALCOLLEGE AND HOSPITAL, BELGAUM.
11.6 SIGNATURE
12. / 12.1. REMARKS OF THE
CHAIRMAN AND PRINCIPAL
12.2. SIGNATURE