Angina pectoris

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[Dr. A.L. Blackwood]

This is a disease characterized by excruciating pains in the cardiac region, a sense of utter powerlessness, and fear of impending dissolution. It has been divided into two varieties.

True angina is most frequently met with in males who are past forty years of age. A large proportion of these cases show fatty degeneration of the heart, with sclerosis or calcification

of the coronary arteries; while in other cases it has appeared to depend upon aortitis, adherent pericardium, cardiac hypertrophy, aortic regurgitation or stenosis, and arterial sclerosis.

In certain families there appears to be a hereditary tendency to development of such conditions as produce these paroxysms. Derangement of the alimentary canal, dilatation and

distention of the stomach, and toxic agents as tobacco, tea, coffee and alcohol have each at times been recognized as causes. In many, the attacks are precipitated by over exertion

or some pronounced mental emotion. The pseudo angina occurs in neurasthenics or the hysterical, during the early part of life and is frequently associated with uterine or ovarian irritation, dysmenorrhea and salpingitis.

Pathology: It should be remembered that angina pectoris is a neurosis, no definite pathological change being constant, and yet structural changes are so frequently associated that they

demand attention. Among these changes are interstitial myocarditis with arterial sclerosis, especially of the coronary arteries, as well as fatty degeneration, and gummata with its

attendant fibroid changes. Apart from the sclerosis as already mentioned, endarteritis deformans and obliterans have their influence, especially as they affect the nutrition of the heart.

With this group should be placed structural changes in the aorta and coronary arteries and occlusion of the openings of the latter. Neuritis of the cardiac plexus of nerves has been

demonstrated in a few cases.

Symptoms: True angina pectoris begins suddenly, usually during some mental emotion or marked exertion. The patient is seized with a most excrutiating pain, griping in characacter,

rendering the body motionless and involving the whole chest. The pains radiate to the left shoulder and arm, at times the right is involved. The pains may be felt in the neck and back

and accompanied by a sensation of coldness and numbness, and a sense of impending death. The countenance becomes pale and is bathed in a cold perspiration. The respirations are

shallow, but the patient can breathe deeply. The heart’s action may be regular and the arterial tension is usually increased. The duration of the attack varies from a second or two to

an hour or longer, and is followed by eructation of gases, vomiting or passage of large quantities of pale urine.

The pseudo angina occurs most frequently in females of the hysterical and neurasthenic type, who suffer from derangement of the uterus and its appendages. There are frequently

symptoms of disturbance of the vasomotor system. Careful examination reveals the hysterogenic spots and anesthetic area. The recurrence of the attack varies; it may return at any time,

or months and years may intervene. If the patient is careful not to become exhausted and is of a calm disposition, the intervals between the attacks may be lengthened. It has been

observed that as dilatation of the heart takes place, the attacks become less frequent and less severe.

Diagnosis: This is dependent upon the pain which comes quickly, is most severe in and confined to the region of the heart, and radiates to the shoulder, the mental anxiety; and the

inability of the patient to move. He is past the meridian of life and is apt to present indications of circulatory disturbances.

Pseudo angina is seen most frequently in hysterical and neurasthenic females. The attack is often produced by some emotion. The patient does not keep quiet, and the pain may radiate

all over the body. Neuralgia of the heart is found from tobacco and alcohol, but there is the odor and other evidences pointing to these as the cause. Lead poisoning is indicated by

the abdominal colic, the blue line on the gums, and the constipation. Intercostal neuralgia and cardiac asthma should be remembered as they have been mistaken for angina pectoris.

Prognosis: In real angina this is always grave, especially if there is arterial sclerosis, disease of the valves, or myocardial degeneration. If fatty accumulation is the cause, the prognosis

is more favorable. In those cases where it is dependent upon a toxic condition, its removal renders the prognosis better. In those cases where it is due to neurotic condition, recurrence

is common, but it does not kill.

Treatment: If anything permanent is to be accomplished by treatment, a most careful examination of the individual case must be made. Not the attack alone, but the habits of the

patient, his family history and environments must all be studied in every possible light. In the management, each case must be considered separately and the causes that excite an

attack sought after. Many of these patients already have recognized the cause in their own case and often it is some irregularity of diet, exercise or mental condition. Many times it is

not an easy matter to control the mental state, as the worry and strain of business life presses upon many of these patients, and is responsible for many cases of arterial degeneration

that give rise to apoplexy, Bright ‘s disease, aneurysm or angina pectoris. The age and occupation of the patient, and the condition of the vascular system should be taken into consideration.

Following an attack the condition of the heart may require absolute rest, from a day to a week or more; this is especially true if the attacks are precipitated by a slight degree of exercise,

which shows that the heart is not able to propel the blood under anything but normal conditions. Under no condition should quick movements and strong emotions be associated.

Steady quiet exercise as walking upon level ground is beneficial. If the cardiac weakness is such as to forbid this, massage, or the resistance exercise of the Schott’s method may be tried.

This exercise should not follow immediately after a meal.

 

In many of these cases the diet is most important. Generally they are good feeders on rich and strong food. First the quantity must be reduced, for the great majority eat too much.

All food that distresses the patient in any form should be forbidden (causing flatulence). In cases where there is marked indication of atheroma and calcification of the arteries, those

articles of food that contain an excess of lime, as milk, eggs, cheese, etc., should be eliminated so far as possible. In those cases that are known as false angina, the neurasthenia and

hysteria must be overcome. At times a positive diagnosis that no serious heart lesion is present, is of great benefit to the patient. Some patients know of an approach of an attack due

to some indiscretion in diet, and take steps to relieve the stomach of the offending meal.

During an attack, a pearl containing five drops of the nitrate of amyl should be broken on a towel and the vapor inhaled. This drug will give better results in cases of true angina than

in the false form. One or two drops of the first centesimal of glonoine by the mouth, will often cut an attack short. It is advisable to let the patient have one or both of these drugs with

him, to be taken in an emergency, for it is seldom that a physician can reach the patient in time to render any service during the attack. In giving the patient these drugs he should be

warned of the dangers from them.

In pseudo angina, magnesia phosphoricum in hot water, a dose every 3 - 5 minutes will often bring relief. Cold applications to the chest or swallowing pieces of ice have been known

to break the paroxysm.

 

Nat-i.: This remedy in from 5 - 20 grains 3x daily, will be found to give most excellent results where there is organic disease of the heart, associated with the angina pectoris. There is

oppression in the region of the heart that is attended with a fear of death and a feeling as if something dreadful was about to happen.

Kali-i.: Severe pains in the centre of the chest ext. the shoulder. The pains in the chest are very severe; the patient desires to get into the fresh air; there is oppressed breathing and loss

of voice.

Spong.: Sudden cramping pains within the chest with oppressed breathing and sensation of suffocation. The face is pale, a feeling of nausea is complained of. The lower portion of the

body feels numb while the upper portion is sore.

Cact.: When with the angina pectoris there is an organic lesion. There is a sensation as if the heart were grasped by an iron band preventing its normal movements, with a continuous

palpitation of the heart, < walking, and at night when lying on the left side.

Ars.: When the attacks are periodical, attended with faintness and extreme weakness, <: after midnight/from motion: There is great mental and bodily anxiety with severe pain that

ext. down the arm, and great prostration and dysponea. The surface of the body is cold, and there is marked prostration following the attacks.

Spig.: There is constriction and painfulness in the left side of the chest which arrests the breathing and causes a sensation of suffocation. The palpitation of the heart is pronounced

and the pains are aggravated by motion and leaning forward.

Cupr-met.: Where there is but little vitality; in feeble individuals, with slow pulse that have suffered during a long period. The attacks appear suddenly + great dyspnea, the surface

of the body is cold and blue and there is a tendency to cramps.

Laur.: In recent cases where there is marked structural lesion. The attacks are severe, are attended with great suffering, gasping for breath and loss of speech. The skin is moist and cold.

Aur-m.: The attacks are precipitated by walking in the open air; the palpitation begins and grows worse, and the pain more severe while in the open air; but relief is found by going to

a closed room where the patient can walk for an indefinite period with no discomfort.

Verat.: This remedy will be found of service in functional cases where there is a feeling of impending suffocation, with constriction of the chest and cutting pains that arrest the breathing.

Tab.: When this remedy is indicated there is an intermittent pulse, pallor with cold, clammy perspiration, vertigo and deathly nausea. There are accumulations of white tenacious mucus

in the mouth, and great thirst with deathly nausea and vomiting, which comes in paroxysms and is made worse by motion. The stomach feels relaxed as if sinking in. There is violent

palpitation of the heart with paroxysms of precordial oppression and pain between the shoulders. The pulse is feeble, soft, slow and intermittent. The patient complains of great weakness

and debility, is restless and desires to change his position often.

Lil-t.: This remedy will be found of service in nervous affections of the heart. The patient is usually of the female sex and suffers from ovarian and uterine diseases. Depressed in spirits

and inclined to weep. She feels that things must be done at once but is unable to perform the task, and mental irritation results. The abdomen is distended, and there is such a dragging

downwards of the organs of the abdomen and chest that she supports the abdomen with her hands. She is a subject of morning diarrhea, when there is great pressure in the rectum and

a constant desire to go to stool. There is a constant desire to urinate, which is worse during the day; the discharge is scanty and is followed by a burning and smarting in the urethra.

There is a sensation as though the pelvic organs would press through the vulva, with sharp pains in the ovarian region; she finds relief by pressing the hand against the parts. A constant

distress about the heart is complained of with sharp quick pains, also a fluttering and palpitation of the heart and a feeling “As if it squeezed in a vise”, or was grasped # relaxed.

Her limbs are cold, with burning of the palms of the hands and soles of the feet. < at night; finds relief during the day by keeping busy.

Nux-v.: Should be studied in the gouty, hemorrhoidal patient, where it is frequently indicated.

Acon.: In pseudo angina, has relieved when its characteristic symptoms are present, as well as Digitalis and Naja.

 

[W.A. Dewey]

Spig.: in anguishing substernal pain which radiates to neck and arms, irregular pulse, tendency to syncope, palpitation and sharp stitches in heart, pulse weak and irregular or full and bounding.

Cimic.: pains radiating all over the chest and a sensation as if the left arm were bound to the side. The patient may become unconscious, the heart’s action suddenly ceases, sense of impending

suffocation, and the pulse is weak and feeble.

Kalm.: shooting pains above the heart to the scapula, anguish about heart, pressure from epigastrium to heart.

Kali-c.: stitches from heart to scapula and there is great weakness.

Aur-met.: a pressure on sternum as from a heavy weight

 

Aurum / Stibium / Hyoscyamus = infarct prophylaxis is Aurum/Stibium/Hyoscyamus. Hyoscyamus (henbane) part of this is

indicated when the heart rhythm is put under stress because reproductive processes are not sufficiently incorporated,

essentially means that the sentient and life organization active in the reproductive organs is making itself independent.

The heart is then put under stress by elements coming from the lower human being.

Aurum/Stibium/Hyoscyamus comp. Glob. wa 10 globuli 2 – 3x daily,

Leading symptoms:  • hyperactive/driven, and at the same time

• aggressive and

• prone to rivalries and physical confrontations.

This is one of the "early composite remedies developed on an anthroposophical basis by the circle around Ita Wegman, MD,

at the “Klinisch-Therapeutisches Institut” creating a remedy that stimulates the rhythmic system to overcome "one-sided

tendencies" in both the nerve-sense system and the metabolic-limb system. Gold, antimony and extracts of Hyoscyamus

potentized together to create a new whole.

The gold component (equivalent to D10 in the final remedy) addresses the heart and circulatory system, strengthens wakeful

day-consciousness and particularly effective in cases where the child has too little exposure to the father.

Antimony (D8) helps give structure to metabolic processes (promoting blood-clotting) as well as to mental life (psychiatrically

valuable when the mind is flooded with an uncontrollable mass of chaotic contents).

Hyoscyamus, in the potency used here (equivalent to a D5), impedes compulsive impulses from passing directly into movement and

promotes the development of the rhythmic system (cf. the toxicity of this solanacean alongside of its rhythmically structured form).

The action of this remedy includes a mildly antidepressive component that is helpful to many of these children.

Use of this introductory therapy stimulates the rhythmic system, and many children and families report feeling an

unmistakable beneficent effect from it; at the same time it gives the physician time to get to know child and parents better and

carry out the next therapeutic steps and conversations.

 

[Farokh Master]

The word ‘Angina’ in Latin means ‘I cry’. It is the ischaemia of cardiac muscles due to arteriosclerosis or thrombosis. About 20 new cases suffering from anginal pain are

registered in my center every month. Since Ischemic Heart Disease is a very large chapter, I will only be discussing the management of anginal pain disorders. Patients

come for the relief of pain mainly and also they are keen not to allow the angina to progress into Myocardial Infarction. Almost all cases that come to me are on Coronary

Vasodilators and Disprine. I am very adamant about stopping such drugs as they have their own side effects and the original symptoms of the patient gets masked.

In today’s discussion I shall highlight the therapeutics, which I have verified clinically in my practice.

Anginal pain is an acute manifestation of the on going chronic process of arteriosclerosis.

Miasmatically it is sycosyphilitic in nature. Hence, superficially treating the local symptoms can only give temporary results. With this there stands a danger of suppressing

the original symptoms and making the disease much more chronic. Hence for long-term management, proper constitutional treatment is a must.

My primary focus in today’s discussion will be acute angina where the patient may not be in a position to talk or give a history, where observation on the part of the physician is

very important. The practicing physician should be in a position to remember his Materia Medica pit-pat so that prescription becomes easy. Here are few observations from my

practice. I shall discuss this in point form:

1. For any vague pain in coronary region which is of shooting type, I have used Eryngium Aquaticum 6C and Senecio Aureus 6C, with good results.

2. Whenever spasm of the coronary arteries is demonstrated on an angiogram, there are two remedies that I know which can produce such kind of pathogenesis, viz. Lat-m. and Squilla.

3. Some of the cases of Hypertension with severe angina have been treated by me with the help of Tabacum and Aur-met.

Aur-met.: never be used in an acute angina as it is of no help.

Some two decades ago I was reviewing the work of Dr. M.L. Tyler and I was surprised to read how beautifully she has made a deeper study and application of an injury remedy

like Arnica. Before reading this article I had never used Arnica in coronary artery disease!!! The following points I have digested only after reading the same which I would

like to share:

Arnica.:

a. < at night as important. as Arsenicum.

b. It has a strong fear of death like Aconite.

c. It has a shock like state like Carbo-v.

d. It has offensiveness of discharges like Mercury.

e. It has got a strong desire to be let alone and not to be disturbed like Bryonia.

f. It has got restlessness like Argentum and substernal tightness with constriction like Cactus.

g. It has got aggravation of complaints from slightest exertion like Calcarea.

Garth Boericke has a very large role to play in my practice as I have adopted quite a lot of his literature in my clinical practice. One such remedy which I have learnt from his works

is Secale-cor. I had never used this remedy in past for coronary artery disease, but after studying few cases treated by him I was convinced of it’s efficacy in angina.

The indications, on which I started using this remedy were:

Secale cornutum..

1. Chest pain ext. both arms.

2. Pressing pain in the region of the heart.

3. Sensation of oppression in the heart area.

4. Spasms of the chest.

Initially, when I read the above indications, I thought they are too preliminary and basic and not worth applying. But slowly, I tried to put this in the general picture of Secale-cor.

and then the results started showing. The symptoms of general picture are:

            1. Restless

2. Fear of death.

3. Wants air-condition and fanning.

4. Loves to be rubbed on the chest (with anginal pains).

5. Icy coldness of the extremities.

In cases of angina with a very low ejection fraction, I was prompted by reading the works of Dr. O. A. Julian – remedies:

1. Perhexilinum maleatum

2. Hirudo officinalis

3. Hydrophis cyanocinatus

4. Hippuric acid

Similarly, other rare remedies that have been very useful to me in my hospital practice in cases of severe acute angina are:

Triosteum perfoliatum, Bacillus Proteus, Scarlatinum, and Streptococcinum. (can even reverse the changes in an electrocardiogram).

I have often used remedy: Amylenum nitrosum, but it has not given me encouraging results. Dr. Ghosh from Calcutta has also contributed a lot to my practice of angina.

Through his book I came to know about Pituitaria glandula and since then I did not look back in majority of my cases in angina.

The important indications are: heaviness, constriction and worse on slightest exertion especially in obese patients.

Dr. Boger has a fair share of contribution in my practice; as for example in some of his cases he has used a rare remedy Lactuca virosa, which I have used successfully for the following symptoms of increased frequency of urine with excess of mucus in the throat.

Boericke in its materia medica has mentioned some very rare remedies which are worth a try, they are as follows:

1. Adrenalin

2. Chloroformium

3. Haemotoxylon campechianum

4. Magnolia grandifolia

5. Prunus spinosa

6. Sarothamus scoparius

7. Zincum valeriana

 

 

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