Angina pectoris
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Vergleich: Siehe: Krankheiten
+ Herz
[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