Case Studies 22 : Tripple Vessel Disease
This is a very challenging case of a 46 yrs old man suffering from:
- Coronary artery disease with H/o M.I. twice,
- D.M.,
- Severe HTN,
- Unstable angina,
- Benign enlargement of prostate,
- Obesity ( Weight - 105kg ) and
- Hyperlipidaemia.
He had H/o M.I. twice in 1997 and in 2001. In 2001, after performing Angiography it was diagnosed as “Tripple Vessel Disease” and he underwent bypass surgery.
Despite the surgery he could not return to his routine physical work due to exertional dyspnoea and hypertension. He used to have frequent attacks of angina.
For the past 6 months his breathlessness had increased; so his angiography was repeated & after that he was immediately advised for a Bypass surgery once again due to the critical reports as follows:
Angiography report 10.01.2007:
- Tripple Vessel Disease.
- Proximal LAD : 99% stenosis.
- PCA : 100% block.
- ADA : 80% bifurcation lesion.
Myocardial Infarct :
Heart muscles are supplied blood by two main coronary arteries. The Right Coronary artery & the Left Coronary artery, which has two branches – Left anterior descending and Lt. Circumflex artery.
Infarct is always a result of an occlusive thrombus in the coronary artery. The heart muscles supplied by that artery die completely within 8 hours and this period is very crucial to save the patient. Pain in Chest especially left side is very severe and continuous. It is described as tightness, heaviness, and constriction or gripping pain. Along with that breathlessness, vomiting, sweating and collapse may also be present. Sudden death due to ventricular fibrillation or asystole may occur.
ST elevation and T-wave inversion are the ECG changes that every general practitioner should know to understand the acute emergency. Angioplasty or bypass is required in many patients who do not respond to thrombolytic treatment.
His creatinine level was also found to be slight high.
Patient was very frustrated and depressed as was suggested for surgery for the second time. On the contrary, initial Bypass surgery had not proved helpful for him. There was a strong history of cardiac diseases in his family. His parents died due to M.I. and also his sister underwent angioplasty.
A patient of mine advised him to go for Homoeopathic treatment before undergoing surgery and so he came to my hospital.
This was a very critical case as patient had D.M. along with cardiac complaints. In these type of case accurate selection of remedy is must- otherwise there may be danger to the life of patient.
When he entered in my consulting room, I observed he was stout and well built person with fatty cheeks. He had big forehead and small eyes. He was looking very panicky and uncomfortable. He kept his (Rt) hand on (Lt) side of chest, giving some pressure and rubbing the cardiac region and felt some relief from this activity. Along with that he also had difficulty in breathing. First two buttons of his shirt were open. I observed, in the center of the chest, there was a big scar (Keloid) of previous cardiac surgery.
On examination his B.P. was 230/130. He was hypertensive for past 10 yrs. And his B.P. was not under control even by anti-hypertensive drugs.
Investigations:
30.05.2006 :2D-ECHO:
Akinetic inferior wall and septum LVEF = 45%.
01.03.2006 :USG Abdomen & pelvis :
Rt. kidney is small, contracted & shows fullness of renal pelvis with cortical scarring with dilated right lower ureter. Prostate is enlarged in size& shows homogenous echopattern.
09.12.2006 :
BSL (F) : 230 mg/dl.
BSL (PP) : 360 mg/dl.
Urine Glucose (PP) : Present.
C/C:
1. Pain in chest off & on since 10 years.
- Chest pain – Drawing type.
- Pain wandering around chest. (Rt. side chest → Back → Lt. side chest)
< Eating while. > Fanning.
< Meat+++. > Pressure.
< Cold weather. > Sitting with leaning backward.
< Exertion. > Keeping hand on painful part.
< Stool after.
< Turning in bed.
2. Palpitations since 6 months.
< Coition during and after. >Fanning.
< Ascending & descending stairs.
3. Neuralgic pain in both legs since 5 years.
- (RT) leg > (Lt)leg.
- A/F overexertion.
- It starts from heels and extends upwards to hip joints. i.e. ascending pain.
< Exertion. > Pressure.
4. Obesity since 10 years.
Past History:
- H/o MI in 1997 and in 2001 with CABG in 2001.
- Facial palsy (Rt) side in 1997.
- # Lt. leg 20 yrs before.
- Malaria 1 month ago.
- H/o 120 Kg. weight 5 years before.
- Dog-bite 15 yrs before.
Family History:
- Mother : MI & death.
- Father : MI & death.
- Sister : Angioplasty done.
Physical Generals:
- Habit : Alcohol before CABG.
Stopped since 5 yrs.
Smoking. Now stopped.
▪ Appetite : Good and can’t tolerate fasting; it causes irritability.
▪ Desire : Green veg., Fish, Pungent, Meat, Buttermilk.
▪ Aversion : Sweets and Milk.
▪ Food< : Eggs < Acidity.
Meat < Chest pain.
▪ Thirst : Thirstless.
▪ Tongue : White coated and moist.
▪ Stomach : Acidity off & on since 7-8 yrs.
- Retrosternal burning, sour water brash, with eructation sometimes.
< Pungent, green chilies, eggs, toordal.
< Morning, waking on.
< Loss of sleep.
▪ Perspiration : Profuse on the scalp (occipital).
▪ Urine : Profuse urination. Frequency 2-3 times at night.
▪ Sleep : Disturbed due to urination, soft bed required.
> Head high.
Position : Lies on back.
▪ Thermal : HOT.
Mind:
1. How is your nature?
I lose my temper easily but cool down very soon. I get angry when my wife does not cook good food or does not
serve it on proper time. I understand that she has work to do; but still I can’t control my temper.
Now days, very small things make me cry.
2. How was your childhood?
My father was working in a private company and due to some problem in that company, he was jobless later on.
So I started working early. Being the eldest, I had to take the responsibility and so left education when I was in 8th
std. and became a laborer. It was a tough job but I was happy that I could relieve my father’s financial burden.
3. How is your marriage life?
I share good relations with my wife. But the major grief of ours is regarding issue. My wife had a miscarriage at
the 7th month of the pregnancy. Since then, we have no child. We feel very sad about that. But I engage myself in
continuous work to forget about it. I am working as a machine operator in Private Company.
Although my bypass had been done, I was free from chest pain only for three months. Presently, I don’t have
enough money to spend on my treatment. I would have to beg for money if there is a need of further operation.
Now, I fear that I may die due to pain and I always need company of my wife and some soothing words from her.
Wife: “Doctor, he weeps like a child whenever I am unable to attend him. I have a lot of work; but he doesn't
understand it.”
4. What are your hobbies?
I like travelling & listening soft music.
5. Any tension?
I have very strong fear of death. Whenever these cardiac pains arise, I get tensed. I would like to live long life for
my wife; otherwise she would be left alone.
6. Any sad moment in your life?
I am deeply attached with my family members. Initially my father died and responsibility of family was on my
shoulders. My mother died due to M.I. 10 years before. I feel very sad after remembering her and I used to cry at
times.
Totality:
- Care nurturing desires.
- Attention seeking.
- Forsaken feeling.
- Anticipatory anxiety.
- Fear of death.
- > When occupied.
- Weeping disposition.
- A/F Grief.
- A/F Over responsibility.
- Chest pain > by keeping hand on painful side.
- < Physical exertion.
- < Meat.
- < Eating while.
- Desire : Fish, Green veg., pungent.
- Perspiration profuse.
- Urination profuse.
- Thermal :HOT.
- Miasm :SYPHILIS.
Response:
I gave him one dose of the remedy and got hospitalized as in such type of critical cases, very keen observation
is required. I immediately checked his BP after 15 minutes. It reduced to 180/100 (within 15 minutes) and then, I
allowed him to go for sleep.
Next day, he came with a smiling face saying that he was not having chest pain. But three days later he
complained of severe backache and chest oppression. I was wondering why this should happen? The other
patients in his ward said, “Sir, this man never rests in his bed...He is always roaming outside the hospital. So he
is having pain.”
Upon questioning him, I found that he was walking about 2-3 kms. in the area around my hospital. I strictly
warned him not to leave his bed without my permission. I repeated the same dose again.
I performed his 3D-CCG, which showed many areas of insufficient blood supply in cardiac region.
A week later, his leg pain reduced considerably. He was able to have food without any chest pain. A month later,
I advised him to go for a short walk. He again walked for 2-3 kms., but without any pain or fatigue. When I
discharged him (a month later), he was really fit and healthy. His 3DCCG report on 19.02.2007 was absolutely
normal; showing sufficient blood supply. (His B.P. was 140/90).
He comes regularly for follow up and has no chest pain. His B.P. is also under absolute control.