Integrative management of Congestive Cardiac Failure (Hrudrog) with Ayurveda...

[Full title: Integrative management of Congestive Cardiac Failure (Hrudrog) with Ayurveda and Modern Medicine: A Case Report]

[Find the meaning and references behind the names: Patil, Punam, Madhukar, Mar, Heart, Amit, Ace]

CASE REPORT Mar-Apr 2021 Journal of Ayurveda and Integrated Medical Sciences | Mar - Apr 2021 | Vol. 6 | Issue 2 270 Integrative management of Congestive Cardiac Failure ( Hrudrog ) with Ayurveda and Modern Medicine: A Case Report Dr. Madhukar L. Bhavsar 1 , Dr. Punam N. Khobarkar 2 , Dr. Snehalkumar Patil 3 , Dr. Amit V. Nakanekar 4 1 Professor and HOD, 3 Assistant Professor, Department of Kayachiktsa, Smt. Ajmera Ayurved College, Dhule, 2 Post Graduate Scholar, 4 Assistant Professor, Department of Kayachikitsa, Govt. Ayurved College, Nagpur, Maharashtra, INDIA. I NTRODUCTION Congestive cardiac failure (CCF) is complex clinical problem. There is impairment of heart ventricles ability to fill or eject the blood. In India, Heart disease (CVD and Cardio Myopathy) is first out of five causes for death. In different studies it has been found that the prevalence of death due to heart disease is increasing in which premature age death episode now found prominently [1] It is an changing epidemic also Address for correspondence: Dr. Amit V. Nakanekar Assistant Professor, Department of Kayachikitsa, Govt. Ayurved College, Nagpur, Maharashtra, INDIA. E-mail: amitnakanekar@gmail.com Submission Date: 18/03/2021 Accepted Date: 05/04/2021 Access this article online Quick Response Code Website: www.jaims.in Published by Maharshi Charaka Ayurveda Organization, Vijayapur, Karnataka (Regd) under the license CCby-NC-SA remains clinical and public health problem. Total number of patients living with heart failure is increasing; due large number of risk factors and comorbidities. Symptoms of heart failure are dyspnoea, orthopnoea, oedema, pain from hepatic congestion, and abdominal distention from ascites due to fluid accumulation and fatigue, weakness due to reduced cardiac output [2] According to modern medicine basic treatment principle is using ACE inhibitors, angiotensin II receptor blockers (ARB), as well as mineralocorticoid receptor antagonists (MRA) and beta-blockers. Treatment protocol also focuses on reducing risk factors, managing multi-morbidly and chronicity, as individuals will be living with heart failure longer than ever before [3] The conventional treatment of heart failure is improved in decades but survival and quality life of patients is unsatisfactory. There are some published clinical trial on Ayurveda treatment is adjuvant therapy in management of heart failure. Many herbal A B S T R A C T Introduction: The prevalence and incidence of congestive heart failure (CCF) is increasing. There is no any published case report that shows the treatment of CCF through Ayurveda. This is case of CCF treated with Ayurveda . Clinical findings: A 68 years male patient came with complaints of dyspnoea on exertion, mild orthopnoea associated with chest pain, abdominal distension, and loss of appetite, constipation, bilateral pedal oedema, and dry cough since 1 year. Diagnosis: He was known case of CCF. In Ayurveda it can be correlated with Hrudroga. Intervention: Patient was treated on the basis of treatment principle of Hrudroga. Outcome: There is increase in left ventricular ejection fraction from 25% to 40% within 2 months. ECG was normal, complete relief in symptoms after 2 years course of treatment. Conclusion: This case report give direction to the treatment of CCF through Ayurveda. Hence the further research in this direction is warranted. Key words: Congestive Cardiac Failure, Ayurved, Life Style Modification, Case Report.

[Find the meaning and references behind the names: Sar, Deep, Ray, Min]

Dr. Madhukar L. Bhavsar et al. Integrative management of Congestive Cardiac Failure (Hrudrog) ISSN: 2456-3110 CASE REPORT Mar-Apr 2021 Journal of Ayurveda and Integrated Medical Sciences | Mar - Apr 2021 | Vol. 6 | Issue 2 271 medicines have antioxidant, anti-inflammatory, antiplatelet or hypolipidemic properties. There is need to evaluate potential role of herbal medicine in management of heart failure [4,5] Here a case of CCF initially treated with conventional therapy along with Ayurveda treatment for 21 days. After that only Ayurveda treatment is given along with life style modification by evaluating the causative and risk factors for heart disease as per Ayurveda classics. P ATIENT I NFORMATION A 68 years male patient known case of congestive cardiac failure came in outdoor patient department of Bhavsar Clinic and Research Centre with complaints of dyspnea on exertion, mild orthopnea associated with chest pain, abdominal distension, and loss of appetite, constipation bilateral pedal edema, and dry cough since 1 year. Patient was taking modern medicine physician treatment but not got complete relief. So, he was managed at Bhavsar Clinic and Research Centre. Initially modern medicine treatment was continued along with herbomineral medicine. As patient got relief, he stopped modern medicine treatment and continued herbomineral medicine. General examination He was afebrile with pulse 98/min, blood pressure was 100/60 mmhg, SPO 2 was 98%, pallor, icterus clubbing was absent. Bilateral leg pitting edema was present. Tenderness was absent at bilateral legs. In Ashtavidha Parikshan his Nadi was ( Vatpradhan ), he had constipation, Jivha (~tongue) was Saam (~slightly coated), Mootra (~urine) passed 3 times per day. His Aakruti (~body built) was Krush, Shabd- Spashta, Sparsha - Samshitoshna, Druk (~vision) - Avikrut. Dashavidh Pariksha Prakriti - Vatpittaj, Sar - Awar, Samhanan - Awar, Satv - Alpa, Satmya - Alpa, Aaharshakti - Alpa, Vyamshakt i- Alpa, Desh - Sadharan, Vaya - Vruddhavastha. Systemic examination Respiratory bilateral air entry decreased, Cardiovascular sounds was normal and Central nervous systems were within normal limit. Bowel sound present. Superficial and deep tendon reflexes were also normal. Per abdomen - dull note present on percussion Strotas Parikshan Rasavaha Strotas, Pranvaha Strotas, Purishvaha Strotas Dushti Lakshan were observed. Clinical findings Clinical symptoms of CCF; dyspnoea on exertion, mild orthopnoea, pedal edema, fatigue, anorexia was present in patient Diagnostic Assessment Patient was diagnosed as Congestive Cardiac failure from clinical symptoms and investigations. Details of investigation are mentioned in Table 1. Table 1: Details of investigation Chest x ray (25/12/2007) Bilateral plural effusion, mild cardiac enlargement due to pericardial effusion USG abdomen 25/12/2007 Acitic fluid 2 D Echo 25/12/2007 Dilated LA and LV, global LV hypokinesia, LVEF 15 to 25% very poor, Mild pulmonary hypertension, moderate to severe mitral regurgitation, pericardial effusion 4/2/2008 As compared to previous echo LV function improved remarkably 40% Mild hypokinesia Normal pulmonary arterial pressure. No cardiac effusion ECG 24/12//2007 & 15/01/2008 S wave in I, Nonspecific T flat in II, III, aVF , T Inverted in V 5 and V 6, ectopics, ST changes in V 3,V 4,V 5,V 6,

[Find the meaning and references behind the names: Guna, Kala, Ras]

Dr. Madhukar L. Bhavsar et al. Integrative management of Congestive Cardiac Failure (Hrudrog) ISSN: 2456-3110 CASE REPORT Mar-Apr 2021 Journal of Ayurveda and Integrated Medical Sciences | Mar - Apr 2021 | Vol. 6 | Issue 2 272 14/5/2010 except minor changes in ST changes in V 2 toV 6 Therapeutic intervention The patient was treated on the basis of treatment principle Hrudrog considering vitiation of Vat, Pitta Dosha and Ras Dhatu. Date wise treatment mentioned in table 2 and rationale of treatment is mentioned in table 3. Table 2: Date wise treatment Date Modern medicine Ayurveda medicine Medicine Dose Aushadh Sewana Kala From 25/12/200 7 (First 21 days treatment) 1.Tab Lanoxin 0.25 mg OD (5 days in a week) 2.Tab Lasilactone 50 mg OD 3.Tab Zilos 25 mg OD 4.Tab Vasosprin 30/75 OD 5.Tab Carnitor BD 6.Tab Clodrel 75 mg BD 7.Tab Cordarone 100 mg OD 1. Nardiya Lakshmivilasras 2.Arogyavardhi ni Vati Raspachak Vati Triphala Churna Pushkarmool Churna Punarnavashta k Churna 7 times processed with punarnavashta k kwath 125 mg 500 m g 250 m g 1 gm 500 m g 3 gm Vyane - Udane Rasayan e - Vyane From 16/1/2008 To 14/5/2010 Gradually decrease the dose and Discontinue d modern medicine after 40 days treatment 1.Arogyavardhi ni Vati Raspachak Vati Triphala Churna Pushkarmool Churna Punarnavashta k churna 7 times processed with 500 m g 250 m g 1 gm 500 m g 3 gm Vyane - Udane Punarnavashta k Kwath 2.Nagarjunabhr a Ras 3.Agasti haritaki Rasayan 250 mg 10 gm Rasayan e Rasayan e Table 3: Rationale of treatment Medication Rationale of Ayurveda Treatment Nardiya Lashmivilas ras [6] Site of action - heart, Raktavahstrotas, lungs Acts on vitiated Vat Dosha specificity through Laghu, Sheet, Chal Guna of Vata Acts on Dushya - Ras, Rakta, Mans Actions - Hrudya, hurday uttejak Nagarjunabhra ras [7] Rasayan, Hrudya, used in Hrudrog, Shhothahar Agastiharitaki Rasayan [8] Rasayan used in hrudrog Aarogyavardhini Vati [9] Deepan, Pachan, Hrudya, it is useful chronic heart disease with edema Punarnavashtak Kwath [10] Shothhar Triphala Churna [11] Rasayan, Deepan, Shothhar Rasapachak Vati [12] Deepan Follow up and outcome The outcomes of treatment over the period 2 years of treatment is mentioned in timeline 1. Timeline 1

[Find the meaning and references behind the names: Malik, Low, Rohit, Figueroa, Rahul, Rasa, Med, Prakashan, Good, Jan]

Dr. Madhukar L. Bhavsar et al. Integrative management of Congestive Cardiac Failure (Hrudrog) ISSN: 2456-3110 CASE REPORT Mar-Apr 2021 Journal of Ayurveda and Integrated Medical Sciences | Mar - Apr 2021 | Vol. 6 | Issue 2 273 DISCUSSION The heart is indispensable for all the normal mental and physical activities because entire sense perception depends on heart. Heart is place of Par Ojas and also controller of mind [13] It is the Ojas that keeps the all living beings refreshed. There can be no life without Ojas . It sustains the life and it is located in heart. It constitutes the essence of all tissue elements. In Ayurveda classics states that those who want to preserve Ojas and maintains heart and vessels attached to it in good condition, should avoid factors that may lead to unhappiness. The diet and drugs which are conducive to the heart, Ojas and channels of the circulation should be taken [14] There are five types of Dosha accompanies in heart these are Pran Vayu (vitiation shows dyspnoea on exertion, cough, drowsiness), Vyan Vayu (Vitiation shows increased heart rate, swelling at ankle joint), Sadhak Pitta (vitiation shows loss of confidence), Avalambak Kapha (vitiation shows cardiac dilatation). According to Ayurveda, dysfunctional Rasa Dhatvagni is a cause of Hrudrog (heart disease). Symptoms of Hrudroga are abnormal complexion, fainting, fever, cough, hiccough, dyspnoea, thirst, mental confusion, anorexia [15] Physical exertion, anxiety, fear, suppression of natural urges such as sleep, stool, flatus are causative factors of heart disease [16] In human defecation is primarily involuntary process and when stool comes to rectum it is voluntarily control. This activity regulated by central, spinal, peripheral, entericneural in synchronized manner. When the process of defecation is not occurred in coordinated manner leads to dyssynergic activity. In Ayurveda it can be correlated with forceful stimulation ( Veg Udgiran ) or forceful suppression ( Veg Dharan ) of natural urges. It causes the Hrudrog (heart disease) [17] In this patient causative factor Veg Vidharan is evaluated and advised to avoid forceful stimulation and suppression of defecation The patient was treated on the basis of treatment principle of Hrudrog . Use of herbomineral medicine that improves Ojas , Agni , function of Rasavaha Strotas . Avoidance of causative and risk factors of hearts disease such as sleep deprivation, exercise, and suppression of natural urges such are advised to patient. There are some published clinical trial on management of CCF in which Panchakarma treatment modalities as adjuvant therapy along with conventional therapy. There is no any published case report on treatment of CCF through Ayurveda . This case is treated with Ayurveda herbomineral medicine. Limitation of this case report is as case is old there is lack of details in terms measurement of recovery of symptoms in terms of gradation. There is also recall bias. CONCLUSION This case report give direction to the treatment of CCF through Ayurveda. Hence the further research in this direction is warranted. Patient perspective: Patient is satisfactory with Ayurveda treatment. REFERENCES 1 Figueroa MS, Peters JI. Congestive heart failure: Diagnosis, pathophysiology, therapy, and implications for respiratory care. Respir Care. 2006 Apr;51(4):403-12. PMID: 16563194. 2 Malik A, Brito D, Chhabra L. Congestive Heart Failure. [Updated 2020 Aug 10]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2020 Jan-. Available from: https://www.ncbi.nlm.nih.gov/books/NBK 430873/ 3 Groenewegen A, Rutten FH, Mosterd A, Hoes AW. Epidemiology of heart failure. Eur J Heart Fail . 2020;22(8):1342-1356. doi:10.1002/ejhf.1858 4 Rohit S, Rahul M. Efficacy of heart failure reversal treatment in patients with low ejection fraction. J Ayurveda Integr Med . 2018;9(4):285-289. doi:10.1016/j.jaim.2017.08.004 5 Sane R, Aklujkar A, Patil A, Mandole R. Effect of heart failure reversal treatment as add-on therapy in patients with chronic heart failure: A randomized, open-label study. Indian Heart J . 2017;69(3):299-304. doi:10.1016/j.ihj.2016.10.012 6 Gune G., Ayurvediya Aushadhigundharmashastra, Chaukhamba Surbharti Prakashan, Varanasi, 2017, Chapter 4, pg no 34-41 7 Shastri A, Baishajyaratnavati, Reprint 18 th edition Chaukhamba Surbharti Prakashan, 2019, Chapter 33, verse 36-38, pg no 692

[Find the meaning and references behind the names: Nil]

Dr. Madhukar L. Bhavsar et al. Integrative management of Congestive Cardiac Failure (Hrudrog) ISSN: 2456-3110 CASE REPORT Mar-Apr 2021 Journal of Ayurveda and Integrated Medical Sciences | Mar - Apr 2021 | Vol. 6 | Issue 2 274 8 Charak Samhita, Chikitsasthan, Trimarmiya Chikitsa Adhyaya 26/99. Available from:http://niimh.nic.in/ebooks/echarak (Accessed on 5 march 2021) 9 Gune G., Ayurvediya Aushadhigundharmashastra, Chaukhamba Surbharti Prakashan, Varanasi, 2017, Chapter 2, pg no 31 10 Tripathi B, Sharangdhar Samhita, Madhyam Khand, Reprint edition, Chaukhamba Surbharti Prakashan, Varanasi, 2013, Chapter 2, verse 118,pg no. 100 11 Tripathi B, Sharangdhar Samhita, Madhyam khand, Chaukhamba surbharti prakashan, Varanasi, 2013, chapter 6 verse 9-11 ,pg no 117 12 Charak Samhita, Chikitsasthan, Jwar Chikitsa Adhyay 3/200. Available from:http://niimh.nic.in/ebooks/echarak (Accessed on 5 march 2021) 13 Charak Samhita, Sutrasthan, Arthedashamahamuliya Adhyay 30/6,7. Available from:http://niimh.nic.in/ebooks/echarak (Accessed on 5 march 2021) 14 Charak Samhita, Sutrasthan, Arthedashamahamuliya Adhyay , 30/13,14. Available from:http://niimh.nic.in/ebooks/echarak (Accessed on 5 march 2021) 15 Charak Samhita, Chikitsasthan, trimaryiya Chikitsa Adhyay 26/78. Available from:http://niimh.nic.in/ebooks/echarak (Accessed on 5 march 2021) 16 Charak Samhita, Chikitsasthan, trimaryiya Chikitsa Adhyay, 26/77. Available from:http://niimh.nic.in/ebooks/echarak (Accessed on 5 march 2021) 17 Baikampady SV. Vata dynamics with special reference to cardiac disorders - A cross-disciplinary approach. J Ayurveda Integr Med. 2020 Oct-Dec;11(4):432-439. doi: 10.1016/j.jaim.2020.10.005. Epub 2020 Nov 17. PMID: 33218848; PMCID: PMC 7772479. ******************************* How to cite this article: Dr. Madhukar L. Bhavsar, Dr. Punam N. Khobarkar, Dr. Snehalkumar Patil, Dr. Amit V. Nakanekar. Integrative management of Congestive Cardiac Failure (Hrudrog) with Ayurveda and Modern Medicine: A Case Report. J Ayurveda Integr Med Sci 2021;2:270-274. Source of Support: Nil, Conflict of Interest: None declared. Copyright © 2021 The Author(s); Published by Maharshi Charaka Ayurveda Organization, Vijayapur (Regd). This is an open-access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/4.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

Other Health Sciences Concepts:

[back to top]

Discover the significance of concepts within the article: ‘Integrative management of Congestive Cardiac Failure (Hrudrog) with Ayurveda...’. Further sources in the context of Health Sciences might help you critically compare this page with similair documents:

Ayurveda, Heart disease, Modern medicine, Herbal medicine, Further research, Ayurveda treatment, Panchakarma treatment, Ayurveda medicine, Case report, Therapeutic intervention, Patient perspective, Diagnostic assessment, Treatment principle, Life style modification, Congestive cardiac failure, Risk factor, Sadhak pitta, Patient Information, Ras Dhatu, Clinical finding, Rasa dhatvagni, Herbo-mineral medicine, Clinical symptom, Vyan Vayu, Avalambak kapha.