Cardiovascular System Problems in GP

Cardio vascular Problems in GP
Cause of Angina Pectoris Presented By
• Prof.Dr.
• R.R.Deshpande
• 9226910630
7/24/2015 Prof.Dr.R.R.Deshpande 1

7/24/2015 Prof.Dr.R.R.Deshpande 27/24/2015 Prof.Dr.R.R.Deshpande 2
Cardio vascular Problems in GP
• Presented By –
• Prof.Dr.R.R.Deshpande (M.D in Ayurvdic
Medicine & M.D. in Ayurvedic Physiology)
• www.ayurvedicfriend.com
• Mobile – 922 68 10 630
• Mailme.drrrdeshpande@rediffmail.com

GP problems of CVS
• 1) Acute chest Pain
•
• 2) hypertension
• 3) Palpitation
• 4) CCF

Acute chest Pain :
• Cardiac Pain
• a) IHD
• b) MI
• Non Cardiac pain
• a) Respiratory
• b) Oesophago – gastric
• c) Chest wall
• d) functional psychological (cardiac neurosis)
• Neurosis : like a Benign tumour of the mind.

Cardiac Pain :
• Chest pain = cardiac pain unless proved
otherwise
• Diagnosis is confirmed by ECG and other
symptoms
• Symptoms : retro sternal pain –
constricting pain shown by clenched fist.
• Cardiac Neurosis – Neurosis is like Benign
Tumor of mind

IHD : Ischaemic Heart Disease
• Causes :
• 1) Less O2 supply : Arteriosclerosis –
arteries – layer means tunica intima are
rough
• Atherosclerosis : Deposition of
cholesterol on rough arteries.
• IHD is caused by less O2 supply or
increased demand of O2 due to LVH in
chronic hypertension or vascular spasm

Angina Pectoris
• 3 types according to duration and
intensity.
• 1) Stable or classical Angina
• 2) Unstable angina
• 3) M.I.

Angina cause
7/24/2015 8Prof.Dr.R.R.Deshpande

Angina Pectoris

Stress Test

Stable angina Pectoris
• Due to transient ischaemia – caused by
vascular spasm – recovers by rest.
• Pain is lasts for maximum 2-5 mins.

Unstable Angina (Pre infarction)
• More severe, lasts longer
• Due to transient blood loss, fissuring and
disruption of Atheromatous plaque,
forming a thrombus.
• When Thrombolysis occurs, crisis ends.
• If thrombus not dissolve & coronary
artery is occluded – Necrosis of cardiac
tissues occurs then heart attack occurs
(MI)

Stable or classical Angina
• i) Generally it occurs between age 50 – 60
years
• ii) Acute chest pain : radiating towards
• a) left shoulder b) Ulnar surface of hand
and arm c) back d) neck e) jaw

• Precipitating factors
• 1) Hurriedly climbing up steps
• 2) Heavy meal
• 3) Anxiety and stress
• 4) Straining for defecation
• 5) After sexual intercourse

• Treatment during attack
• Relieved by a) Complete rest – for 2-5
mins.
• Short acting Nitrates -- Glyceryl trinitrate –
(Angised) 0.5 mg or Isosorbide dinitrate 5
mg (Tab Sorbitrate) or Nitroglycerine spray
• Once the pain stops – spit or swallow tab
• Throbbing headache – side effect

Stable & Unstable Angina

• Nifedepine (Cap Depin)10 mg –
• bitten by the patient – releases the liquid (
absorbed sublingualy)

Atypical presentation of
Angina pectoris
• i) Anginal decubitus : This pain occurs at
night, when the patient is recumbent.
• ii) Varient Angino or Prinz metal's angina :
Chest pain at rest with palpitation and
breathlessness.

Atypical presentation of
Angina pectoris
• iii) Wenback's second wind Angina :
Pain starts white / after walking pain
stops spontaneously without
vasodialators.

• 1) ECG should be taken during exercise
called stress test or treadmill test.
• ST depression in lead II or V1 to V6.
suggests Ischaemia
• 2) 2D Echo : To see the how much
damage cardiac tissues. see the EF –
Ejection faction if it is less than 50 % then
suggest weak heart

• 3) Angiography : To see whatever the
damage is due to coronary artery block or
not and to see the which vessel block and
how many blocks are there.
• Angiograpy is imp. to know whether the
disease is
• 1) One vessel, 2) Two vessel 3) Three
vessel – Then CABG (Case is serious)

Prevention of Anginal Attacks :
• 1) Modification of life style :
• 2) Avoid the risk factors
• 3) Adequate rest
• 4) Proper exercises which will not
precipitate to M.I. (Breathing, yogic
exercises – best)

Prevention of Anginal Attacks
• 1) Planning and time table
• 2) Fatty food , high calorie diet, excessive
sweets, chocolates should be avoided
• 3) Rest – Rule of 8 -- 8 hours hobbies and
with family, 8 hours sleep & rest , 8 hours
for bread butter (job)

Prevention of Anginal Attacks
• Drugs :
• a) Nitrates
•
• b)  blockers
•
• c) Ca antogonists
• d) Anti-platelet

Treatment of Angina

Nitrates : Coronary vaso-dialators
• 1) Glyceryl trinitrate – short acting (Tab
Angised ) or
• 2) Long acting Isosorbide Dinitrate –
(Isordil or sorbitrate ) 5 mg 8 hourly or
• 3) Isosorbide 5 mononitrate (Ismo 20 or
Monotrate 20 mg tds
• GIN – Glycerl trinitrate ointment or
Transdermal patches

-blockers
• Reduce the oxygen requirement of heart
by reducing HR & BP and myocardial
contractility.
•
• Atenelol – Tab Aten – 25-100 mg / day.OD
• Should be started along with Nitrates

Ca Antagonists
• This is powerful coronary and peripheral
vaso-dialator.
• Therefore give increase or adequate O2
supply and reduced O2 requirement.
• Blocks the entry of Ca into myocardial
cells.
• Therefore reduced the contractivity.

Ca Antagonists
No Name Dose
1 Nifedipine
(Cap Depin,Calcigard)
10 to 40 mg
TDS
2 Amlodipine(Tab Amlogard) 5– 10 mg OD
3 Verapramil(Tab Isoptin) 80-120 mg TDS
4 Diltiazem (Tab Dilzem) 30—90 mg TDS

Anti – Platelet
• Thrombus dissolving action.
• Aspirin – Acytel – calycitric acid – Its powerful
analgesic.
• Tab – Aspirin also known as 'Magic bullet' for
heart patient
• Doses – 100 – 150 mg/day.(Disprin)
• Inhibit the aggregation of platelets.
• Cheap & proved effective
• Well understood side effect profile.

Anti – Platelet -- Contraindication
• 1) In peptic ulcer & 2) Hypersensitivity
patients.
• For this patients
• 1) Tyclopidine 250 mg – BD (Tab – Tyklid)
• Side effects : effect starts after 5 days.
• Neutropenia – So Adv Haemogram per
week.
• 2) Clopidogrel – (Tab – clopiget) 350 mg –
stat & 75 mg BD.

Ayurvedic Advice for Angina
• Rule out the cause and treat accordingly e.g. anemia,
syphilis, hyper thyroidism, paroxysmal tachycardia.
• Advise obese to reduce weight.
• Keep away from bad habits like smoking, alcohol,
tobacco,excessive coffee or tea etc.
• Control diabetes and hypertension with proper
medication.
• Do not exert too much. Have enough rest

Ayurvedic Advice for Angina
• Do not suppress or force natural urges like
urine and stool.
• Regular bowel movements.
• Avoid over indulgence of sex.
• Avoid excessive sweat, sour and salty
food.

Ayurvedic Medicines
for stable Angina
• Bruhat Vatachintamani 30-60 mg. with
ginger juice.
• Harinshrung Bhasma 175 mg. +
Laxmivilas 50 mg. with ginger juice

Prevention of progress
of Angina
• For prevention use following for 3 months
• Makardhwaja 60 mg. + Shrung Bhasma
125 mg. each morning and
Mahalaxmivilas 125 mg. + Sitopaladi
Churna 750 mg. afternoon and night.

Unstable Angina or
Pre Infarction Syndrome
• Known case of stable Angina – In this case if
• 1) Pain more severe, last longer, occur with
increasing frequency.
• 2) Pain occurs at rest kin known case of stable
Angina.
• 3) Pain associated with vomiting, dyspnoea &
perspirations.
• 4) Pain not relieved completely by sublingual
nitrates.

Unstable Angina or
• Diagnosis : Transient ECG changes – This are
'ST" elevation / depression and 'T' Inversion.
• Changes revert back to normal in 24 hours.
• Since No necrosis
• Suspect MI when ?
• 1) ECG changes no revert back in 24 hours.
• Cardiac enzymes levels are increased

Unstable Angina or
• For the Heparinization admit the patient.
Its also called – Thrombolytic Therapy.
• Give Inj – Streptokinase (I/V) or
Urokinase

Coronary Arteries 2

Acute M.I.
• Symptoms : 1) Severe retrosternal constricting
chest pain – radiating.
• Infrascapular (back pain)
• Left shoulder, jaw, neck & epigastrium
• Vomitting / Nausea
• Profused sweating
• Incontinance of urine or stool
• (Complete rest even – bed pan gives on bed)

Acute M.I.
• Sympathetic stimulation ---
• Tachycardia, palpitation, restlessness,
sweating.
• Parasympathetic stimulation ---
• Bradycardia and hypotension

Atypical M.I. or Silent Inforct
• 1) No pain in long standing DM, HT, elderly or
middle aged post-operative patient.
• 2) Sudden sweating and vomiting, with or
without chest pain.
• 3) Sudden breathlessness with or without chest
pain.
• 4) Acute confusion , severe unexplained,
weakness, arrhythmia, syncope, sudden death

How you can diagnose
the pain of M.I. ?
• Patient is restless
• Moving on bed.
• Profuse sweating, cold extrimities.
• Anxious, pale – Face
• Pulse – Brady or Trachy or Normal
• B. P. -- Hypo or Hyper or normal

Acute M.I.
• If there is doubt then repeat the ECG.
• RS – Brasal creptitions
• ECG – i) ST elevation, but
• ii) After 24 hours – 'T' inversion

Types of MI

MI

Area of Infarct

MI – ST Elevation

Area of Infarct Table

Acute M.I. -- Blood investigations
• 1) CPK – MB
• 2) SGOT
• 3) LDH
• 4) Cardiac Froponin – T (with 5 hours) costly but
confirmatory.
• 5) Sr. Myoglobin – very sure if it is positive.
• Above all enzymes are in the enzymes come
from cardiac necrosed tissue. In blood this
enzymes level increases.
• When there is muscle degeneration when level
of SGOT is increased.

Acute M.I. --Before hospitalization :
• 1) Sublingual – Tab Angised 0.5 mg or Tab
Sorbitrate 5 mg.
• 2) To dissolve the thrombus– Disprin 100 – 150
mg.
• 3) For severe pain – Inj. Fortwin – 30 mg I/M
• 4) When bradycardia due to cardiac shock then
gives Inj – Atropin 0.3 to 0.6 mg I/V
• 5) In known patient of LVH gives – Inj – Lasix 20
– 80 mg I/V diuretics)
• If B.P. falls down rapidly -- Shift the patient
immediately in the hospital

ECG Waves

ECG Changes in MI

Ayurvedic Medicines after Acute
attack of MI
• For stable patients : Use following medicines
• (1) Bruhatvatachintamani Rasa 1 Tab. 2 times a day.
• (2) Shrungabhasma 250 mg. 3 times a day.
• (3) Vatavidhvansa Rasa 2 Tab. 3 times a day.
• (4) Khurasanai Ova 100 mg. 3 times a day.
• (5) Prasham 4 tablespoon with equal amount of water at
bed
• time.
• (6) Triphala Churna 1 tablespoon with warm water at bed
time.

Prevention of further
Heart Attack
• 1) Suvarnabhasma 6 mg. + Makardhwaja
50 mg. + Shrungabhasma 250 mg. 2 times
a day with honey. Or
• 2) Hrudayanarva Rasa (B) 1 Tab. 2 times
a day +Nagarjunabhra Rasa 2 Tab. 3
times a day + Yakuti Rasa 2 Tab. 3 times
a day+ Prabhakar Vati 2 Tab. 3 times a
day.

Hypertension
• Mild – 90 – 110 mm of Hg.
• Moderate – 110 – 130 mm of Hg
• Severe - > 130 mm of Hg

Rheumatic Mitral Stenosis

Dial BP Apparatus –
Visiting Bag

Damage by Hypertension

Hypertension
• 1) Most of the hypertension is Idiopathic.
• 2) Secondary Hypertension – Renal RFT
• Hepatic – USG, LFT
• adv. 2D Echocardiogram – Cardiac – Valvular
defect
• Acc. to symptoms – hormonal (T3, T4, T3H etc)
• RFT – Renal Function Test -- Urea, Creatinine
• In every Hypertension patient adv. – USG of
abdomen and some time Renal angiography

Hypertensive Heart

Hypertension -- Treatment
• Mild hypertension – No Drug treatment.
• Life style management – Planning, time management.
• Reduced stress – Meditation, Yoga, Pranayam
• Restriction of Salt, pickle, papad, fast food, and
preservative foods, wafers all are restricted.

• Deep fried food are avoided and
unsaturated oil use e.g. sunflower oil
• Regular walking – Collateral circulation are
develops.
• Reduced weight if high weighs.
• Stops alcohols, tobacco, cigars etc

• Monodrug Therapy 1)  - Blockers
• Tab – Aten – 25 – 50 mg & 100 mg – 1 – 0
– 0
• 2) Ca – channel blocker
• Tab – Stamlo 2.5, 5 mg – 1 – 0 – 0
• 3) ACE – Inhibitor Tab – Enam – 5 to 10
mg.

Moderate Hypertension --
Treatment
• Mono drug – Maximum dose or Combination
treatment
• Either  - Blocker + Ca chanel blocker or
(minimum dose)  - Blocker + ACE inhibitor
• Compliance of patient is very imp. + Diuretic –
Lasix 40 mg 1 OD.

Moderate Hypertension --
Treatment
• Kesol – To avoid lasix's side effect
• Diuretic drugs – Potassium sparing
diuretics
• Tab- Biduret, Tab – Lasilactone -
diurectics

Severe Hypertension
• Malignant H. T.
• Medical Emergency
• Admit instant -- Treatment is of hospital level
• Symptoms :
• 1) Severe Headache
• 2) Vomiting
• 3) Visual
• 4) Convulsions, paralysis (transient)
• 5) Coma

Accelerated H. T.
• Medical urgency
• At level of G.P. (No serious complaint of
patient)
• Diastolic > 130 , but without symptoms
like in Malignant HT, which you can treat
primarilty
• Cap – Depin – 5 mg gives sublingulal,
repeat after 10 mins, till the B.P. comes to
110.

Accelerated H. T.
• Then cap – Depin 10 mg TDS (1 – 1 – 1)
• Tab Aten – 50 mg BD
• Tab- Lasix – 40 mg BD
• If the BP doesn’t come down 110 within 24
hours then admit the patient.

Ayurvedic Medicines for
Hypertension
• Hypertension ( Pitta avruta vata) –
• Duralabhadi ( Dhamasa) Kadha -- 4 tsf
with equal amount of water BD
•

Ayurveda for Mild Hypertension
• Diastolic less than 90 mm of Hg
• (i) Siledin ( Alarsin ) 2 Tab. 3 times a day.
• (ii) Sapera forte (charak ) 2 tab. at bed
time.

Ayurveda for
Moderate Hypertension
• Diastolic in-between 90-100 mm of Hg
• (i) Abana 2 Tab. 3 times a day. And
• (ii) Punanarnavasava 4 tablespoon with
equal amount of water 2 times after meals.

Ayurveda for
Severe Hypertension
• Diastolic more than 100 mm of Hg
• Suvarna Sutshekhar 30 mg with honey every 5 minutes.
• Rasagandha (AYR) 2 Tab. 3 times a day.
• Sutshekhar Rasa sadha 2 Tab. 3 times a day.
• Arogyavardhini 2 Tab. 3 times a day.
• Duralabhadi kwath 4 tablespoon with equal water 2
• times after meals.

Ayurveda for
Severe Hypertension
• Diastolic more than 100 mm of Hg
• Arogyavardhini 2 Tab. 3 times a day.
• Gokshuradi Guggulu 2 Tab. 3 times a day.
• Rasayana Churna (HP) 1 tablespoon 2
times a day.
• Siledin (A) 2 Tab. at bed time

Vaman – Useful to reduce Cholesterol
• High Cholesterol like above 300 mg % -- cause
Atherosclerosis – leads to Hypertension
• Diet control + Lovastatin like medicines can reduce
cholesterol very slowly like 20 mg in 6 months
• But Vaman ( Therapetic Vomition ) with prior Snehapan
with Tiktak Ghee 50 mg daily + Fomentation ,can show
magic results for reducing Blood Cholesterol level +
Internally
• Tab Arogyavardhini 3 TDS + Tab Triphala 1 TDS +
Nagarmotha & Vidanga churna each 3 Gm TDS

Palpitation
• 1) Cardiac – Paroxysmal ventricular
Tachyeardia or Extrasyslole (Take history)
• 2) Non cardiac – i) Hyperthyroidism ii)
Hypoglycemia
• 3) Functional – Cardiac Neurosis
(Psychological)

Pulse Examination

Heart Palpitation

Palpitation
• Tab – Ativan (Lorazepam) – 1 mg stat –
BD for 4 days
• Tab – Inderal – 10 – 40 mg TDS
• Also a anti anxiety or anti stress drug.
Therefore Anti Arrythmic (acts physically
and mentally also)

Hyper & Hypoglycemia
• Diabetic ketoacidosis – Hyper glycemia
(fruity odour)
• Hypoglycemia is always fatal because
brain can dead within 2 min if less or no
supply of glucose.
• Insulin dependent patient ,if do fasting.
• Profuse sweating and acute incidence.
• Give the I/V glucose – 25 %

CCF – Congestive Cardiac Failure
or Cardiac Asthma
• LVF (Left Ventricular Failure)
• RVF (Right Ventricular Failure)
• Cardiac Asthma is the breathlessness ,
during CCF.

Symptoms of CCF

Symptoms of CCF 2

CCF
• Treatment At GP level
• 1) Bed rest completely
• 2) Salt free diet (because of salf is hygroscopic
nature)
• 3) Fluid intake restricted (Inj. Lasix – 40 mg stat.
or tab lasix – 40 mg BD)

CCF
• liq. Kesol – 1 TSF – TDS with glass of
water.
• or pattasium soarina diuretics are used
such as
• Tab Amifru – 1 – OD or
• Tab Lasilactone – 1 – OD

CCF
• For the heart :
• Lanoxin – 0.25 mg 1 OD for 6 days (Sunday off)
• Inj – Aminophylline 10 ml diluted in 20 ml of 25
% dextrose.
• This inj.-- give very very slow (for 30 ml – 10
min)

Congestive Heart Failure

CCF
• B.P. control – Tab Enam 2.5 mg BD
(Enalapril)
• Infection – control by Cap – Ampiclox – 50
mg TDS
• If till there is no control then give adv. for
Hospitalisation

Ayurvedic Medicines for CCF
• Shrungbhasma 2 Tab. 3 times a day.
• Vishatindookvati 1 Tab. 3 times a day.
• Punarnavasava 4 tablespoon with equal
amount of water 2 times after meals.

Ayurvedic Cardiac Tonic
• 1) Arjunarishta(Parthadyarishta) -- 4tsf
with equal amount of water BD in CCF
• 2) Arjun Kshirpak --- 50 ml BD in patients
of Angina Pectoris

X ray of CCF

Shock ,Pulse less patient
• Shock,Pulse less patient ----
• In Emergency Life saving drugs in
Ayurveda –
• Tab Laxmi vilas rasa
• Hemagarbha Chatan or licking

Conducting system of Heart

Ayurved & Yoga – Good help for Heart Patients
• Ayurvedic Internal Medicines
• Ayurvedic Detox Therapies or Panchakarma &
allied procedures
• Yoga Asanas
• Pranayam
• Meditation
• Everything can be helpful for Heart patients ,but
always under guidance of Expert

Abhyanga
• Gentle ,soft Full body
massage helps to
improves Blood
circulation, Providing
good nutrients to
cells, remove the
waste products
efficiently
• Soothening to body &
Mind

Shirodhara –
Beneficial to reduce Blood pressure
• Oil shower on head
controls hyper activity
of sympathetic
system
• Reduces stress
• Cool down irritability
of mind
• Produce sound sleep

Hrud Basti – Heart Tonic
• Improves tone of
Cardiac muscle
• Improves elasticity of
vessels
• Very Good Analgesic
& Anti-inflammatory
action
• Reduces Anginal pain

Raktamokshan or Blood letting –
Good to reduce Hypertension
• Reduces blood
volume
• Reduces cardiac load
• Stimulation for proper
blood circulation
• Removes Impurities
or Ama or Endo
toxins from blood

Pranayam –Deep breathing Practice
• Proper perfusion of
Oxygen
• More Energy to
cardiac muscle
• Heart function
improves

Meditation – Best Relaxation
• Best way for
maintaining
Homeostasis
• Physical Rest
• Mental Tranquility

Yoga Postures for Heart Patients

Ayurved for General Practioner
• Very very popular
Book in Medical
Practioners
• 100 common
symptoms of General
Practice with
causes,Investigations
& Ayurvedic
Treatments

Clinical Examination
• Systemic Examination
of 8 systems
• Ayurvedic Srotas
Examination
• Clinical significance of
Lab Tests &
Radiology,USG,2D
Echo

Notes on Medicine Part 1
• Very very useful Book
for all Medical
Practioners
• Guidelines with
causes,symptoms,Ay
urvedic & Modern
Treatments to treat
Fever,Pain in
Abdomen & Arthritis

Best Book for
Medical Students & Practioners

Preventive Cardiology
& Ayurvedic Management
• Best Book for GP
• All cardiac problems
like
Hypertention,CCF,
Angina,Myocardial
Infarct are discussed
with Ayurvedic
Management
Contact -922 68 10 630

Digestive Problems
& Ayurvedic Management
• All Digestive
problems like
Acidity,Pain in
abdomen,
• Constipation ,colitis
are discussed with
Ayurvedic
Management
Contact -922 68 10 630

Gynaecological Problems &
Ayurvedic Management
• All Gynaecological
problems like Heavy
bleeding,White
discharge,Infertility,ca
ncer are discussed
with Ayurvedic
Management
Contact -922 68 10 630

Arthritis,Backache &
Ayurvedic Management
• All Joint problems
like Rheumatoid
Arthritis,Osteoarthritis
,Backache are
discussed with
Ayurvedic
Management
Contact -922 68 10 630

Neurological Problems & Ayurvedic
Management
• All Neurological
problems like
Headache,Epilepsy,Al
zeimer’s Disease are
discussed with
Ayurvedic
Management
Contact -922 68 10 630

Ayurvedic Concept of Diet
& Nutrition
• Dietary Advice
according to Prakruti
,Dietary prescriptions
for many diseases are
given
• Contact -922 68 10
630

Health Tips for 365 Days
• This Book is very
useful from Common
man to Doctors
• It covers all imp
aspects mentioned in
Ayurveda
• Open as per date &
complete reading of
one page only

Prof.Dr.Deshpande’s
Popular Links on Internet
• Just Start Internet on Desk top or Lap top
or on your mobile . Copy Following Link &
Paste as Web address –URL
• http://www.youtube.com/user/deshpande1
959
• http://www.slideshare.net/rajendra9a/
• http://www.mixcloud.com/jamdadey/

Prof.Dr.Deshpande’s
Popular Links on Internet
• Just Start Internet on Desk top or Lap top
or on your mobile . Copy Following Link &
Paste as Web address –URL
• http://professordeshpande.blogspot.in
• http://professordrdeshpande.blogspot.in/
• http://www.mixcloud.com/rajendra-
deshpande
• https://soundcloud.com/professor-
deshpande

Prof.Dr.R.R.Deshpande
• Sharing of Knowledge
• FOR
• Propagating Ayurved

Cardiovascular System Problems in GP

Recommended

Recommended

More Related Content

What's hot

What's hot (8)

Viewers also liked

Viewers also liked (18)

Similar to Cardiovascular System Problems in GP

Similar to Cardiovascular System Problems in GP (20)

More from rajendra deshpande

More from rajendra deshpande (20)

Recently uploaded

Recently uploaded (20)

Cardiovascular System Problems in GP