of congestive cardiac failure, treated successfully in the Inpatient
department of National Institute of Homoeopathy under Dr. Subhash
Chaudhary, Lecturer and his team is presented here.
·An old male aged 70, Muslim,
resident of a rural area near Kolkata, was admitted to NIH hospital
and he presented with
1. Progressive severe breathlessness for 3 months.
2. Swelling of dependent parts (lower limbs) for 20 days.
3. Associated with fatigue, tiredness and palpitation.
History of present complaint:
From about 3 months patient has been developing
severe breathlessness < lying down+++, talking++, on slight
exertion, 4 am. > in open air, bending forward, desire for
fanning. Swelling of lower limb, which increases most prominently
in evening. Previously he took allopathic treatment; but he developed
medicinal intolerance. Associated fatigue feeling and sensation
of pressure drawing inward from epigastric region to back.
Recurrent cough & coryza, chickenpox, typhoid, and ulcers
Respiratory difficulty (Uncle).
Tobacco chewing, smoking.
1. X-ray: (13/07): Clear lungs. Obscured Right
costophrenic angle, most likely by pleural effusion. Cardiomegaly.
2. ECG: (28/06): Tachycardia with irregularity.
3. USG: (21/07): Normal other than a small cyst
in Rt. Kidney but it was noticed that patient has bilateral pleural
effusion as well as pericardial effusion.
4. Blood test: Hb%= 12.2gm; TLC= 4,600; DLC=
N:74%, L: 23%, M:0%, E :3%, B:0%; ESR= 02 mm; Serum urea: 28.9
mg/dl; Serum creatinine : 1.0 mg/dl.
5. Urine R/M = Normal.
Discussion on Homoeopathic Management:
This is a case of CCF, which in itself indicates
a condition with advance pathology and acute emergency. This was
treated with application of all homoeopathic principle, with the
use of both low and high potency successfully. After Repertorisation
and discussion with Materia Medica it was clear that the case
required Pulsatilla and prescribed but on third day severe aggravation
observed. Hence, Digitalis 3X was prescribed to stabilise the
acute condition. With Digitalis 3X after two days severe palpitation
was controlled but oedema increased on dependent parts, and massive
hydrocoele developed with decrease in urine output. Therefore,
Apis Mel 30 prescribed and followed by Apis Mel 200 on next day.
Patient got relief of dyspnoea but no changes in progressive oedema
with no change in urine output observed.
Cardiologist advised for urgent need of diuretics
and shift to allopathic hospital but the patient wanted to continue
with homoeopathic management and was not willing to go because
of previous intolerance with allopathic treatment, then Strophanthus
Q was prescribed. On next day, it was observed that urine output
improved and came to normal in 8 days. On 28/07/10 patient again
complained of decreased in urine output and increased pedal oedema
with constipation and < in warm room and > open air. On
these, Symptoms Pulsatilla 200 prescribed and patient again started
improving, and patient became symptom free on 04/08/10. Now our
aim was to withdraw the Mother tincture as its action has been
achieved. Hence, Strophanthus Q was stopped and Pulsatilla 0/2
OD was started. Patient was kept under observation for 7 days,
no recurrence of symptom found with stable general condition (Refer
the plate before and after treatment).
So on 09/08/10 patient was discharged from hospital
IPD and asked to continue follow-up in OPD.
Comparison of follow-up investigations:
Improvement in condition was concluded by comparison of previous
and recent investigations:
Chest X-ray (13/07/10): Obscured right costophrenic
angle, most likely by pleural effusion. Cardiomegaly.
Chest X-ray (22/08/10): Clear and hyperinflated
lungs, well defined diaphragm and costophrenic angles. Cardiomegaly
shown. [There is no longer any evidence of pleural effusion]
ECG on (28/06/10): Reported tachycardia with
ECG done later (27/08/10): Still showed some
variations in intervals between beats but the heart rate now was
about 100 per minute instead of the original 120 per minute.
This discussion is an attempt to describe the
homoeopathic approach planned to relieve the patient of Congestive
Cardiac Failure with homoeopathic medicines. When keen observation
of the conditions or symptoms is done periodically, along with
use of indicated remedy in appropriate potencies (low and high)
then its desired effect of providing relief to the patient can
be achieved. In this case it has been demonstrated how action
of homoeopathic medicines have helped to successfully stabilise
the action of the heart in a patient suffering from a disease
as severe as Congestive Cardiac Failure.