Documenti di Didattica
Documenti di Professioni
Documenti di Cultura
APPROACH TO
CARDIOLOGY
Prof. Dr. S. N. Ojha
M.D. Ph.D (Ayu)
Director,
Post Graduate Studies
Yashwant Ayurved College Kodoli
Kolhapur
A aerobic organ.
- Seat for oja
Indriya
atma
pranvayu
HRIDAYA
sadhak pitta
avalambak
kapha
mana
vyanvayu
demand
energy
workload
Pranvahasrotas
Rasavahasrotas
Raktavahasrotas
Hridaya
Udakvahasrotas
Shonita kapha
prasadat
Srotamsi anya ca darunaihi
Contribution in pathogenesis of
Heart diseases
Epidemology
1.5 million people die of CVD every year.
2.4 million people suffer from IHD
India suffers the highest loss in potentially
productive years of life [ 35-64 years ]
By 2030, the loss is expected to rise to
17.9 million / year.
Prevalence of CVD is reported 2-3 times
higher in urban area than rural population.
Aetiology
A] Beej swabhavat sthula matapitrujanya
bhavat.
B] Previous exposure to behavioral risk
factors such as
i) Avyayam (Insufficient physical activity)
ii) Inappropriate nutrition
Diet deficient in fresh fruit, vegetables and
polyunsaturated fatty acids are associated
with an increased risk of vascular disease.
may
enhance
the
production
of
oxidized LDL.
Elevated
Homocysteine
level
confers
an
platelet
abnormalities,
abnormal
Fat
consumption
expenditure
as
induces
most
is
very
little
stored.
energy
Meda
eva
mellitus.
Insulin
resistance
is
vridhi
in
madhumeha
leading
to
hridroga.
General Symptoms
Vaivarya mrcch jvara ksa hikk vssyavairasya trr pramh|
chardikaphtkla ruj'rucicahrrdrgajsyurvividhstath'ny||
Ca.Ci.26/78
Confusion/unconsciousness
Distress/pain/
Hriths
hool
Dhamani pratichaya
- common in area where rheological forces
act.
Factors responsible for genesis of Dhamani
pratichaya
1) sama meda
2) Vyan vata
3) injured dhamani or strotas.
Sama meda
mahabhuta)
Pratighata &
apratighata.
pratighat.
pratighat.
exerts pressure
sama
medha
having
sanga
property
contribute to dhamanipratichaya/
atherosclerosis
demand.
disparity
Apatarpan & dhatu kshaya in
hridayasthan
Impaired
saman
Supply
&
agnivyapar
Due to
avrita
Apana
Intermediates Metabolites
are not excreted from
Cardiac Cells
IHD
dipaniyaghrita (omega - 3 fattyacid.)
Avrita vyan
vata
dhatu poshak
rasa
in hridaya sthan
Kitta of dhatu
metabolism do not
come out & retain in
hridayasta anu
strotas
impairs dhatu poshan
Coronary Atherosclerosis
Dhamani
Thrombosis
Hridayasta
Pratichaya
Grathita Rakta
Narrowing Of coronary
Artery
Myocardial Ischaemia
Apatarpana
Srotosanga/Avarodha
(Hridayastha)
Chest Pain
Vataprakopa
I.H.D.
Hrithshool(Chest Pain)
Vatika Hridroga:
Etiology /Causative Factors / Sadhyo Nidan
vyymatktivirkabasticintbhayatrsagadticr|
chardymasandhraakarannihrrdrgakartrr
r itath'bhightaII
Ca.Ci.26/77
Kalantar Nidan:
kpavsavyymarkauklpabhjanai [1]
vyurviya hrrdaya janayatyuttam rujamII
[Ca.Su.17/30]
grief,
fasting,
excessive exercise,
intake of unctuous food,
dry and
inadequate quantities of food,
Excessive Emotions
Adhyashan
Heavy meals
Dhoomrapana
Smoking
Tremors
Excruciating pain, cramps,
stiffness,
Feeling of darkness/ getting blank,
feeling of sense of emptiness,
Worsening of pain after the digestion of food
hrrcchnyabhva drava a
bhda
stambhsamhpavandvi
a|
1.
2.
3.
4.
5.
6.
7.
8.
9.
10.
11.
ANGINA
THE ENGLISH WORD ANGINA REFERS TO
A PAINFUL CONSTRICTION TIGHTNESS
SOMEWHERE IN THE BODY
AND MAY REFER TO :
ANGINA PECTORIS
ABDOMINAL ANGINA
LUDWIGS ANGINA
PRINZMETALS
ANGINA
VINCENTS ANGINA
ANGINA
TONSILLARIS
Chest discomfort
Symptoms
Subtypes
Stable angina is typically presented as
chest discomfort and associated
symptoms precipitated by some activity
(running, walking etc.) with minimal or
non-existent symptoms at rest.
Unstable Angina
It occurs at rest (or with minimal
exertion), usually lasting > 10 min;
it is severe and of new onset (i.e., within
the prior 4-6 weeks);
it occurs with a crescendo pattern (i.e.,
distinctly more severe, prolonged, or
frequent than previously).
Diagnosis
Electrocardiogram (ECG)
Exercise ECG Test (Treadmill Test)
Thallium Scintigram
Stress Echocardiography
Coronary Angiogram
Differential Diagnosis
bhukt'dhikajryatilamalpajrsthitac
tII
jr'dhiklam II
yadijryatisyt lam II
Against
1.Character of Pain
Constricting
Squeezing
Burning
Heaviness, heavy feeling
Dull ache
Knife Like,Sharp
stabbing,jabs
Aggravated Respiration
2. Location of Pain
Substernal
In the left submamary area
Across Mid Thorax,
In the Left hemithroax
Anteriorly
In both arms, shoulders
In the Neck, Cheeks, Teeth's
In the Forearms, Fingers
In the interscapular region
Against Ischemic
origin
3. Factors Provoking Pain
Exercise
Pain after completion of exercise
Excitement
Provoked by a specific body motion
Other forms of Stress
Cold Weather
After Meals
Pittaj Hridroga
heartburn,
bitter taste in the mouth,
eruptions with bitter and sour taste,
exhaustion,
thirst,
unconsciousness,
dizziness,
Perspiration.
1.
2.
3.
4.
Kaphaja Hridroga:
atydna gurusnigdhamacintanamacanam|
nidrsukha cbhyadhika
kaphahrrdrgakraam || Ca. Su.17/34
Excessive intake of food,
Intake of heavy and unctuous food,
Inadequate mental exercise,
Sedentary habits,
Excessive sleep
stabdhagurusytstimitacamarma
kaphtpraskajvaraksatandr|
Bradycardia,
heaviness
timidity of heart /dullness
associated with salivation,
Fever,
cough and
Drowsiness
Sannipatik hridroga
vidyttridatvapisarvaliga||Ca. Su. 26/80
All of the previously mentioned symptoms of all
the three dosa are manifested together.
This type of heart disease is caused by the
combined vitiation of all the three doa.
This can be diagnosed by the existence of the
various signs and symptoms of all the three
types of heart diseases.
This type of heart disease is very painful and
difficult to cure.
tvrrtitdakrrmijasakam
Hridroga Samprapti
Agnimandyak
ar Nidan
Aama
Aamavisha
Doshprakop
Nidan
Khavaigunya
kar Nidan
Sanchaya
Rasavaha
Strotasa
Vaigunya
Dhatudaurbalyak
ar Nidan
Rasadhatwagni
becomes upahata
Prakopa
Sansrishtena
Prasar
Vyadhi Virodhikatwa
and
pratibandhakatwa
Bala hani
Aamavisha
Rasanugata
Rasa dhatu
becomes sheethila
Sthana
sanshraya
in the moola of
rasavaha
Srotas, Hridaya
Doshdushya
sammoorchhana
Cont
Sanga dushti
Atipravruti dushti
The haani of
vikshepan
Karma of
vyanavata
The hyper
functioning of
hridaya koshas
Hani of
Poshan
Of Hridaya
koshas
(apatarpan of
koshas)
Aati visfarana
(dilatation)
of hridayasth
Mansapeshi
Hridvridhi
(cardiomyopathy)
Again vata
Vridhi
Siragranthi
dushti
Deposition of
aama in
hrithkapata
Vikriti of
hrithkapata
Pranvaha and
rasavaha
strotodushti
janya
Vikara
Rheumatic
heart diseases
Vimargagaman
Dushti
Pranavaha
strotodushti
janya
Vikara
Backward
transmission
and pressure
from Left heart
to lungs
Pulmonary
hypertension
C.H.F.
Hrithshool
(I.H.D)
Sthaulya
Resistance
to fulfill
the demand
Pranvahasrotodushti
L V Stroke Volume
Contd.
contd.
No change in heart
rate
Shwas
Pulmonary Arterial HTN
Cardiac Output
Hridayam badha Kurvanti
Dosha Hridayam
Gatva
R V H & Enlargement
RVF
(Hridroga)
LV Enlargement
Hypertension
L V Wall Stress
Hridayam badha
kurvanti
LVH
LV Systolic Dysfunction
LV Diastolic
Dysfunction
L V F (Hridroga)
Peripheral
Vikar vighata bhava
Non Osmotic Vasopressin Release
Vasopressin V2 Receptor
Aquaporin- 2
Increased water permeability of collecting duct
Bahya Sira Prapya
Water Retention
Shoth
Marmoghata
Left VentricularFailure
IHD
Myocarditis
Valvular Heart Disease
Restrictive Pericarditis
Cor Pulmonale
Right sided Valvular Disease
Right sided Myocardial Disease
Pulmonary Hypertension
Activation of RAAS
Myocardial Contractility
Vata
Cardiac
workload
Tachycardia
Cell Stretching
(vyas is among vata vridhi
lakshana)
Further stress on myocardium (Vikar Vighat abhav)
Compensatory
Hypertrophy
CCF
Dilatation
&
Systolic Dysfunction
Coronary Artery Disease
Hypertension
Valvular Heart Disease
Diastolic Dysfunction
Hypertension
Coronary artery disease
Hypertrophic obstructive cardiomyopathy
(HCM)
Restrictive cardiomyopathy
HYPERTENSION
Risk Factors
Hypertensive emergency
Ahypertensive emergency(Systolic over 180 or diastolic over
120)
(formerly
called"malignant
hypertension")
is
hypertension with acute impairment of one or more
organ systemsthat can result inirreversibleorgan damage.
(especially thecentral nervous system, cardiovascular system
and/or therenal system)
Causes
autonomic hyperactivity
collagen-vascular diseases
Glomerulonephritis
Head trauma
Neoplasias,
PreeclampsiaandEclampsia
Renovascular hypertension
Neurological Cardiovascul
ar
Renal
acute
renal failure
or
insufficiency
retinopathy
Epistaxis,
Dyspnea
cerebral vascu
lar accident
/
cerebral infar
ction
subarachnoid
,
hemorrhage
acute left
ventricular
dysfunction
eclampsia
acute
pulmonary
edema
microangiopat Vomiting
hic
hemolytic an
emia
intracranial
hemorrhage
aortic
dissection
Severe
anxiety
Paresthesias
Agitation
Altered
mental status
Pathophysiology
Aortic Stenosis
Aortic stenosis(ASorAoS) is the narrowing of the exit of theleft ventricleof
theheart.
It may occur at theaortic valveas well as above and below this level.
Causes
rheumatic fever
Old age
Symptoms:
heart related chest pain (Angina) occurs due to AS the outcomes are worse
Signs of heart failure:
heart murmur
Pathogenesis
Increased age
Abnormal
Predisposition
Haemodynamic
Forces
Calcium
Lipid
Metabolism
Dhatukshaya
Kha vaigunyakar
(meda)
Janya vata prakopa
dhatvagni mandya
Bija dushti
(asthi)
sama
osteoblast
osteoblastic differentiation
Aortic
Valve Calcification
cells
calcium deposition
on collagen scaffold
stimulate
accumulation
formation of foam
pro-inflammatory factors
Aortic Stenosis
Systolic murmur
S2 Loud
Ejection Sound
Lt. Ventricular Out flow Obstruction
Sanga
C.O.
Vimargagaman
Pranavaha Srotodushti
Shwasadi
vaata
Chest pain
Diagnosis
Pulsus Parvus et tardus: Slow and/or sustained upstroke of the arterial
pulse, and the pulse may be of low volume.
Apical-carotid delay: Noticeable delay between thefirst heart sound(on
auscultation) and the corresponding pulse in thecarotidartery.
In a similar manner, there may be a delay between the appearance of
each pulse in the brachial artery and the radial artery.
The first heart sound may be followed by a sharp ejection sound
("ejection click") best heard at thelower left sternal borderand the
apex, and, thus, appear to be "split".
An easily heardsystolic, crescendo-decrescendo (i.e., 'ejection')murmur
is heard loudest at the upper right sternal border, at the2nd right
intercostal space,and radiates to thecarotid arteriesbilaterally.
The murmur increases with squatting and decreases with standing and
isometric muscular contraction such as theValsalva maneuver, which
helps
distinguish
it
fromhypertrophic obstructive cardiomyopathy
(HOCM).
The second heart sound (A2) tends to become decreased and softer as
the aortic stenosis becomes more severe.
One may hear afourth heart sounddue to the stiff ventricle.
When dilatation of the ventricle will occur, a third heart sound may be
manifested.
Aprecordial thrill
Mitral stenosis
Mitral stenosisis avalvular heart diseasecharacterized by
the narrowing of the orifice of themitral valveof theheart.
Signs and symptoms:
Heart failuresymptoms,
such
asdyspnea on exertion,
orthopnea andparoxysmal nocturnal dyspnea(PND)
Palpitations
Chest pain
Hemoptysis
Ascitesandedemaand
hepatomegaly
(if
right-side
heart failuredevelops)
Causes:
Mitral Stenosis
SI Loud
Sanga
Vimargagaman
Pranavahastrotodushti
Cardiac Output
Rasavikshepana
Apatarpana
Bhrama (Giddiness)
Shaitya (cold Extremities)
Heen Nadi (Low Volume Pulse)
Shyavata (Cyanosis) etc.
Systolic Murmur
Mitral Valve
Incompetence
Vimargagaman
Pranavahastrotodushti
Hridayadushti (R.H.F.)
Vimargagaman
Rasavaha, Raktavaha Strotodushti
Shotha
Yakriddalyudar
Jalodar
JVP (Siranamayam)
Diagnosis
Tappingapex beat
(Avrit
(Avrit
))
Uda
Uda
na
na
(Avaraka)
Pran Vayu
Prayatn
Prayatn
a
a
Urdhwa
Urdhwa
Gati
Gati
Varna
Varna
Urja
Urja
Udan
Udan
aa
Karm
Karm
aa
Bala
Bala
Udana
Udana karma
karma hampered
hampered due
due to
to
avarana
avarana of
of Prana
Prana
mis
mis matching
matching
Sangraha
Sangraha of
of nishwas
nishwas and
and uchshwas
uchshwas
Failure
Failure of
of control
control over
over immune
immune System
System
Auto-immune
Auto-immune Disorders
Disorders
Rheumatic
Allergic
Rheumatic Heart
Heart disease
disease
Allergic
Rhinitis
Rhinitis
(Hridroga)
(Shiroroga/
(Hridroga)
(Shiroroga/
Pratishyay)
Pratishyay)
Pran
Pran Avrit
Avrit Udana
Udana
Treatment
Treatment
Ashwasana
Ashwasana Chikitsa
Chikitsa
Saman
Saman Avrit
Avrit Apan
Apan
(Avrit
)
Apa
na
(Avaraka)
Samana Vayu
Saman
Saman Avrit
Avrit Apan
Apan
Agnisand
Agnisand
h-ukshan
h-ukshan
Muncha
Muncha
n
n
Vivecha
Vivecha
n
n
Saman
Saman
a
a
Karma
Karma
Dharan
Dharan
Pachana
Pachana
Saman
Saman Avrit
Avrit Apan
Apan
Due
Due to
to vitiated
vitiated Saman
Saman Vayu
Vayu
The
The No.
No. of
of intermidiete
intermidiete
dharan
dharan
Metabolite
Metabolite inceases
inceases
ItIt Obstruct
Obstruct the
the Gati
Gati
Of
Of Apan
Apan Vayu
Vayu
Ischemia
Ischemia
moves
moves
(Hridoga)
(Hridoga)
Begins
Begins
Unable
Unable to
to
Apakwa
Apakwa ahara
ahara
Grahani
Grahani
Apakwa
Apakwa ahara
ahara
forward
forward
Parshwashool
Parshwashool
Samana
Samana avrit
avrit Apana
Apana
Treatment
Treatment
Agnidipak
Agnidipak Ghrita
Ghrita
Apan
Apan Avrit
Avrit Vyan
Vyan
(Avrit
)
Vyan
a
(Avaraka)
Apan Vayu
Apan
Apan Avrit
Avrit Vyan
Vyan
Apana
Apana Vayu
Vayu
Restrict
RestrictGati
Gatiof
ofVyan
Vyanvayu
vayu
between
between
Atipravrutti
Atipravrutti
Vyan
Vyan
Mutra
MutraPurisha
PurishaRetasa
Retasa
of
of
Avrita
Avritato
to
karma
karma
reduced
reduced
Interplay
Interplay
Gati
Gatiof
ofApan
Apan&&
Srijan
Srijankarma
karma&&gati
gati
Apana
Apanavayu
vayu
Vyan
Vyanvayu
vayu
Rasavikshepan
Rasavikshepan
Of
OfVyan
Vyanvayu
vayu
Apan
Apan Avrit
Avrit Vyan
Vyan
Diarrhoea
Diarrhoea
Dehydration
Dehydration
Decrease
Decrease ventricular
ventricular feeling
feeling
Heart
Heart rate
rate &
& Vasoconstriction
Vasoconstriction (Peripheral)
(Peripheral)
Dehydration
Dehydration
Cardiac
Cardiac Output
Output
Reduced
Reduced Rasavikshepana
Rasavikshepana
Hypovolumic
Hypovolumic shock
shock
Apan
Apan Avrit
Avrit Vyan
Vyan
Treatment
Treatment
Sangrahan
Sangrahan
Vyan
Vyan Avrit
Avrit Udana
Udana
(Avrit
)
Vyan
(Avaraka)
Udana Vayu
Vyan
Vyan Avrit
Avrit Udana
Udana
Paroxymal
Paroxymal Tachycardia
Tachycardia
Abnormility
Abnormility in
in the
the different
different portion
portion of
of Heart
Heart
(( Atria/
Atria/ Purkinj
Purkinj Fiber/
Fiber/ ventricles)
ventricles)
Rapid
Rapid Rhythmic
Rhythmic discharge
discharge of
of impules
impules
Spread
Spread in
in direction
direction
throught
throught the
the Heart
Heart
Re-entrant
Re-entrant Pathway
Pathway
Causes
Causes ischemic
ischemic
Damage
Damage
Vyan
Vyan Avrit
Avrit Udana
Udana
Continue
Continue
There
There is
is never
never co-ordinate
co-ordinate contraction
contraction of
of
ventricular
ventricular muscles
muscles at
at once
once which
which is
is
required
required
for
for cardiac
cardiac pumping
pumping
Causes
Causes
Dizziness
Dizziness
Fatigability
Fatigability
Dypsnoea
Dypsnoea
(Bala
(Bala ,, Prayatna
Prayatna Reduced)
Reduced)
Aaharatmak
apekshani
2. Prakritim anupahatya
3. Yatha kalam jaram gachathi
4. Aahar matra Sarvagraha
Parigraha
5. Aahar prakriti anurupa dwividha
prakar
guru na agni sandukshan,
Prudent Diet:
B) Viharatmak
Vyayama nitya sevan
sharira chesta ya chesta sthairyartha
balavardhini
Deha vyayama sankhyata matraya tam
samacharet
Ca. Su. 7/32
Ativyayama nisheda
Vyayama hasya, bhasya adhwa
gramyadharma prajagaran
Nichitan api sevan bhudhiman ati matraya
Ca. Su. 7/34
Avoid Smoking
Prevent stress
Follow aachar rasayan
MEDICINE
Maricha
Chitrak
Daruhari
dra
Rason
Tulsi
Vacha
Pushkarmool
a
Punarnava
Shilajeet
Triphala
Amrita
Musta
Pippali
Kutki
Drugs explained
in Urustamba,
sthaulya and
santarpanotha
vyadhi chikitsa
can be chosen.
Kamalkshar
Utpalnal kshar
Darbha
Kusta
Paravatashakri
Asana
Role of katu
rasa pradhan
dravya should
be studied
since Charak
says it has
shonita
sanghata
bhinnati
action.
Mrinal
Palash kshar
Priyangu kshar
Amalaki
Haritaki
Punarnav
a
Shatavari
Shalparni
Sariva
Manjista
Shilajeeta
Amrita
Yastimadh
u
Patola
Kutki
Vidanga
Laksha
Vasa
Amrita
Punarnava
Amalaki
Pushkarmool
a
Kusta
Kachora
Kantakari
Brihati
Lagupanchamool
a
Somvalli
Haridra
Daruharidra
Bharangi
Yastimadhu
Pippali
Mrigashringa
Dashamoo
la
Haritaki
Rason
Guggulu
Punarnava
Shalparni
Shatavari
Pushkarmoola
Deodaru
Mrigashringa
Nagbala
Brahmi
Sankhapushpi
Jatamansi
Guduchi
Yastimadhu
Shatawari
Haritaki
Brahmarasayan
Punarnav
a
Gokshur
Musta
Ushir
Dashmula
Varun
Pashan bheda
Brahmi
Padmak
Pundarik
Madhuk
Arjun
Brahmi
Tulsi
Guggulu
Punarnava
Rason
Shatawari
Amalaki
Yastimadhu
Kalpa
Hridayarnav Rasa
Dadimadya Ghrita
Navayas churna
Prabhakar vati
Arjunarista
Hartone
Arjin
Cardomac
DOUBTS??
Thank you