This document provides information about a case of dilated cardiomyopathy in a 26-year-old female patient. She had a history of Ewing sarcoma and chemotherapy treatment as a teenager, which likely caused her cardiomyopathy. She presented with symptoms of pedal edema, cough, nausea, chest discomfort on exertion, shortness of breath, and weakness. Her echocardiogram showed a reduced ejection fraction. She was initially treated with allopathic medications but sought Ayurvedic treatment for continued symptoms. Her case details, medical history, examination findings, and proposed Ayurvedic treatment plan are summarized.

1. GUIDED BY :
Prof. Vd. SURENDRA A. SONI
M.D.(AYU.Ph.D )
H. O. D.
PRESENTED BY :
DR.NISHITA LIMBACHIYA
2nd YEAR PG SCHOLAR
P.G. KAYACHIKITSA DEPARTMENT
POST GRADUATE DEPARTMENT OF KAYACHIKITSA
GOVT. AKHANDANAND AYURVEDA COLLEGE & HOSPITAL, AHMEDABAD, GUJARAT.

2.  “Cardio” = Heart , “ Myo” = Muscle , “Pathy” = Disease
 An acquired or hereditary disease of Heart muscle
 It is a type of progressive heart disease in which heart
muscles become abnormally enlarged, thickened, or thinned,
stiffened and weak.
 As a result there is damage to the muscle tone of the heart and
reduces its ability to pump blood to the rest of the body, often
causing arrhythmias and heart failure.

3. 1. DILATED CARDIOMYOPATHY
2. HYPERTROPHIC CARDIOMYOPATHY
3. RESTRICTIVE CARDIOMYOPATHY
 It is a type of heart muscle disease that
causes the heart chambers (ventricles) to thin
and stretch, growing larger. Resulting in
difficulty to pump blood to the rest of the
body.

4. In which the heart muscle becomes
thickened (hypertrophied). The thickened
heart muscle can make it harder for the
heart to pump blood.
In this, the ventricles become stiff & rigid due
to replacement of normal heart muscle with
abnormal tissues such as scar tissue and
becomes less elastic, so it can't expand & fill
with blood between heart beats. Which
causes the atria become enlarged.

5.  Most Common type
 The heart muscles begins to dilate, meaning it Stretches and becomes thinner.
Consequently, the inside of Chambers enlarges.
 Characterized by dilatation and impaired contractibility of one or both ventricles
 Due to impaired contractibility the dilated ventricles are unable to eject all the
blood out of the heart resulting in reduced ejection fraction.
More common in between the ages of 20 and 50.

6.  Inherited
 Inflammatory Myocarditis (Infective / Non infective )
 Toxins
 CERTAIN CHEMOTHERAPY DRUGS
 Metabolic disorders
 Idiopathic

7. Due to etiological factors
Inflammation and rapid degeneration of myocardial fibers
Ventricular dilation
Blood flow is stagnant or slow in an area in the chambers of
dilated heart

8. Ventricles ability to pump blood reduces significantly
Atria enlargement
Decreased blood flow
blood clot formation
Systemic embolization
Heart failure and other complications

9.  Chest discomfort
 Palpitation , Dyspnea
 Coughing
 Nausea , Abdominal Bloating
 Peripheral edema

10.  History taking
 Physical examination
 ECG
 Echocardiogram
 Chest X –ray
 Endomyocardial biopsy

11. Stroke
Sudden cardiac
arrest
Heart valve
regurgitation
Heart failure
Fluid retention
Jugular venous
distension

12.  Fluid restriction
 Diuretics
 ACE inhibitors
 Beta blockers
 Anticoagulation

13. LVAD ( Left ventricular assist device )
Heart transplantation

14. AYURVEDIC VIEW

15. शोणितकफप्रसादजं हृदयं….
 According to Ayurvedic texts, the heart
originates from the essence of Rakta and Kapha,
predominantly from maternal side, and develops
into a muscular organ
 It is a site of Mana & Chetana and origin of
Rasavaha and Pranavaha Srotasa
 One of the vital point of body
 It is a site of Vyana Vayu, Sadhaka Pitta,
Avlambaka Kapha, Oja.

16. SAMANYA NIDANA
व्यायामतीक्ष्िाणतणिरेकबस्तिणिन्ताभयत्रासगदाणतिारााः|
छर्द्ाामसन्धारिकशानाणन हृद्रोगकतताणि तथाऽणभघाताः || (ि.णि.अ. 26 /77)
SAMANYA LAKSHANA
िैिर्ण्ामूर्च्ााज्वरकासणिक्काश्वासास्यिैरस्यतृषाप्रमोिााः|
छणदााः कफोत्क्लेशरुजोऽरुणिश्च हृद्रोगजााः स्युणिाणिधािथाऽन्ये ||(ि.णि.अ.26/78)

17. VATAJ HRIDROGA
हृर्च्
ू न्यभािद्रिशोषभेदिम्ााः
समोिााः पिनाणिशेषाः| (ि.णि.अ.26/79)
PITTAJ HRIDROGA
णपत्तात्तमोदू यनदािमोिााः
सन्त्रासतापज्वरपीतभािााः|| (ि.णि.अ.26/79)
KAPHAJ HRIDROGA
िब्धं गुरु स्यात् स्तिणमतं ि ममा कफात् प्रसेकज्वरकासतन्द्ााः|
णिर्द्ास्तत्क्िदोषं त्वणप सिाणिङ्ग
ं तीव्राणतातोदं क
ृ णमजं सकण्ड
ू म् ||
(ि.णि.अ.26/80)

18. OJAS
हृणद णतष्ठणत यर्च्ुद्धं रक्तमीषत्सपीतकम्|
ओजाः शरीरे सङ्ख् यातं तन्नाशान्ना णिनश्यणत ||
प्रथमं जायते ह्योजाः शरीरेऽस्तिञ्छरीररिाम्|
सणपािािं मधुरसं िाजगस्तन्ध प्रजायते|| (ि.सू.अ.17/ 74-75)
गुरु शीतं मृदु श्लक्ष्िं बििं मधुरं स्तथथरम् |
प्रसन्नं णपस्तर्च्िं णिग्धमोजो दशगुिं िृतम् ||
(ि.णि.अ.24/ 31)
OJAGUNA
OJAKSHAYA
मूर्च्ाा मांसक्षयो मोिाः प्रिापोऽज्ञानमेि ि | ( Su.su.A. 15/ 24)

19. VISHA GUNA
िघु रूक्षमाशु णिशदं व्यिाणय तीक्ष्िं णिकाणस सूक्ष्मं ि |
उष्णमणनदेश्यरसं दशगुिमुक्तं णिषं तज्ज्ैाः||(ि.णि.अ.23/24)
VISHA GUNA vs OJA GUNA
Sr. no. VISHAGUNA OJAGUNA
1. Laghu ( lightness ) Guru ( heavy)
2. Ruksha ( Dryness ) Snigdha (oily)
3. Aashu ( fast acting) Prasanna ( pleasant )
4. Vishad ( clearing ) Picchila (sticky)
5. Vyavayi ( spreading) Sthira ( stable)
6. Tikshna ( sharpness ) Mrudu (soft)
7. Vikasi ( opening channeles ) Slakshna ( smooth)
8. Sukshma ( fineness ) Bahalam (coarse / thick)
9. Ushna (hotness ) Sheeta ( coolness)
10. Anirdeshya Rasa ( unidentifiable taste ) Madhura ( sweetness)

20. VATAJ HRIDROGA
तैिं ससौिीरकमिुतक्र
ं िाते प्रपेयं िििं सुखोष्णम्|
मूत्राम्बुणसद्धं िििैश्च तैिमानािगुल्माणताहृदामयघ्नम्||(ि.णि.अ.26/28)
PITTAJ HRIDROGA
शीतााः प्रदेिााः पररषेिनाणन तथा णिरेको हृणदणपत्तदुष्टे|
द्राक्षाणसताक्षौद्रपरूषक
ै ाः स्यार्च्ुद्धे तु णपत्तापिमन्नपानम् || (ि.णि.अ.26/90)

21. KAPHAJ HRIDROGA
स्तिन्नस्य िान्तस्य णििणितस्य णक्रया कफघ्नी कफममारोगे|
कौित्थधान्यैश्च रसैिािान्नं पानाणन तीक्ष्िाणन ि शङ्कराणि|| (ि.णि.अ.26/96)
TRIDOSHAJA HRIDROGA
णत्रदोषजे ििनमाणदताः स्यादन्नं ि सिेषु णितं णिधेयम्|
िीनाणतमध्यत्वमिेक्ष्य िैि कायं त्रयािामणप कमा शिम्||(ि.णि.अ.26/100)

22.  Agnideepan
 Aampachan
 Srotosodhan
 Vatanuloman
 Ojovardhan
 Vishapaham

23. PATIENT INFORMATION
Name : XYZ
Age : 26
Gender : Female
Occupation : Job
Address : Ahmadabad
OPD No : 13117
A 26 year young female patient came to OPD No.4 (P.G. Kayachikitsa
department) at Govt. Akhandanand Ayurveda Hospital, Ahmedabad
with following complaints on 10th may 2023 :

24.  Padashotha ( Pedal edema ) - since 1 month
 Kasa (Coughing) - since 1 month
 Hrullasanubhuti (Nausea) - since 1 month
 Gamne Hridshoola (chest discomfort while walking ) - since 1 month
 Daurblya (Weakness ) - since 1 month
 Shwaskastata (Shortness of breath with exertion) - since 15 days

25. The patient was diagnosed as Ewing sarcoma at the age of twelve in 2009. At that time
surgical management was given for the same, after that she was treated with certain
chemotherapy drugs for 2 years, which includes Doxorubicin , Cyclophosphamide etc.
during the treatment of chemotherapy she was suffering from similar symptoms which is
mentioned above, at that time she was consulted with cardiologist and diagnosed as dilated
cardiomyopathy, which was manifested due to toxic effects of chemotherapy drugs. At that
time she was treated for the same with allopathic medicine. after few months she got rid
from symptoms so stop the medicine of DCM, and continued the rest treatment of
chemotherapy. After that she was relatively healthy during the years, but in May 2023 she
was suffering from above mentioned symptoms. She was diagnosed and treated in modern
allopathy hospital as a case of dilated cardiomyopathy , but she not got any relief in
symptoms so she was brought to our hospital for Ayurvedic management, when she came
to our hospital her 2D echo showed 25% LVEF along with congested inferior vena cava.

26. PAST HISTORY
Ewing sarcoma – diagnosed in 2009 (operated in 2010)
Chemotherapy - for 2 years
(chemo drugs -Andriamycin, cyclophosphamide, doxorubicin )
FAMILY HISTORY : Father – HTN
PERSONAL HISTORY
Diet : Vegetarian, junk food (once in a week )
Sleep : Disturbed
Appetite : Less
Bowel movement : 1 time/day
Micturition : 5-6 times /day
Pulse : 90 / min
Respiratory Rate : 21/min
Temperature : Normal

27. 1. Tab. Lanoxin 0.25 mg (1 OD)
2. Tab. Naptaz 50 mg ( ½ BD)
3. Tab. Dytor 10 (1 BD)
4. Tab. Eplar 25 mg ( 1 BD)
5. Tab. Veloz 20 mg ( 1 BD)
6. Complete rest was advised

28. 1. Nadi : 90/ min (Vat-paittik)
2. Mutra : 5-6 times /day
3. Mala : 1 time/day (unsatisfactory)
4. Jihva: Sama
5. Sparsha : Prakruta
6. Shabda : Prakruta
7. Druk : Prakruta
8. Akriti : Madhaym

29. 1. Prakriti : Kapha – Pitta
2. Vikriti : Lakshana nimitta
3. Sara : Mamsasara
4. Samhanana : Madhyam
5. Pramana : Madhyam
6. Satva : Uttam
7. Satmya : Madhyam
8. Aharashakti : Hina
9. Vyayamashakti : Hina
10. Vaya : Yuva

30. 1. Dosha : Pitta - Vata
2. Dushya : Rasa, Rakta, Mansa, Oja
3. Strotas : Rasavaha, Raktavaha, Mansavaha, Pranavaha
4. Stroto dusti : Sanga, saithilya (Atipravrutti – as a broad aspect)
5. Rogamarga : Marmasthisandhi
6. Agni : Mandagni
7. Samta : Sama
8. Adhisthan : Sharir & Manasa
9. Udbhavsthan : Amashay samuttha
10. Vyaktisthana : Hrudaya
11. Swabhav : Chirkari
12. Sadhyaasadhyata : Kricch sadhya

31. Anticarcinogenic drug ( Pradhanika Nidana)
Pitta – Vata prakopa
(due to similar guna of Visha)
Shleshma kshaya
( Oja guna hani )
RASAKSHAYA
Onward Dhatukshaya
Hrudmarmadusti (Srotovisfar)
(Decresed stability due to effects of vishagunas)
Ojakshaya
RASAVAHA STROTODUSTI
मूर्च्छा मांसक्षयो मोहः प्रलछपोऽज्ञछनमेव च
Loss of िेिो बन्धाः स्तथथरत्वं
(Kapha Guna & Karma)

32. Sr no . Adverse effects Affected Dhatus/Srotas
1 Nausea & vomiting Rasadushti
2 Extreme tiredness/ Exercise intolerance Rasadushti
3 Changes in taste Rasadushti
4 Ulceration Raktadusti
5 Hyper pigmentation of skin Raktadusti
6 Early bleeding Raktadusti
7 Hyperbilirubinemia Raktadusti

33. 8. Muscle weakness Mansadusti
9. Muscle pain Mansadusti
10. Dyslipidemia Medadusti
11. Lethargy Medadusti
12. Bone marrow suppression Majjadusti
13. Joint pain Asthivaha Srotas
14. Temporary/ Permanent sterility Shukradusti
15. Diarrhea / stomach ache Rasadusti / Annavaha Srotas

34. 16. Hair loss Rasavaha / Asthivaha
17. change in nail color Raktavaha / Asthivaha
18. Dizziness Rasavaha
19. Anemia Rasavaha

35. Sr no. PARAMETER
( 03/05/02023)
OBSERVED VALUE NORMAL VALUE
1. BLOOD UREA 18.2 mg/dl 16.6 – 48.5 mg/dl
2. CREATININE 0.82 mg/dl 0.5 – 0.9 mg/dl
3. SODIUM 138 mmol/L 136- 148
4. POTTASIUM 4.8 mmol/L 3.5 – 5.5
5. SERUM FERRITIN 298.6 22 – 322
6. IRON 48.26 ug/ dl 33 - 193

36. THERAPUTIC INTERVENTION
MEDICINE DOSE ANUPANA
Avipatikar churna- 5gm
+Kamdugdharasa-500mg
+Dhatriloha – 250 mg
2 times /day ( before meal) Honey
Agnitundi vati 2 tab BD ( after meal) Water
Chandraprabha vati 2 tab BD ( after meal) Hot water
Punarnava mandur vati 2 tab BD ( after meal) Hot water
Arogyavardhini vati 2tab BD (empty stomach) Manjisthadi kwatha
Manjisthadi kwatha 40ml BD (empty stomach)
As per the condition of the patient following management was started on 10th may 2023

37. OBSERVATION & RESULTS
OBSERVATION & RESULTS
Due to our Ayurvedic management the patient had started
improving in symptoms within 7 days. She got rid of all
sign and symptoms within a month and gradually she
started felling very well, healthy, enthusiastic and
energetic. After completion of 3 months of treatment,
her echocardiography report showed LVEF – 45 % which
was 25% in initial report. In her initial echocardiography
report had finding of congestion of IVC (inferior
venacava) that was normal after 3 months of our
treatment.

38. ASSESSMENT OF DISEASE IMPROVEMENT
SYMPTOMPS BEFORE
TREATMENT
DURING
TREATMENT
AFTER
TREATMENT
Pada shotha
( Pedal edema)
+ + + + ---
Kasa (Coughing) + + + + + ----
Gamne Hridshoola
(chest discomfort)
+ + + + + ----
Daurbalya (Weakness) + + + + + + +
Hrullasanubhuti
( Nausea)
+ + + ----
Swasnekashtata
(Shortness of breath)
+ + + ------

39. 2D ECHOCARDIOGRAPHY
03/05/2023 01/08/2023

40. LATEST FOLLOW UP
On 29/01/2024 echocardiography
was repeated and the improvement
is maintained and there is no other
systemic or other complain.

42.  Ayurveda provides ‘Apunarbhav chikitsa’ (root
eradication) by counter the toxic substances in the body
and to increase the properties of Ojas, that is a substance
through all living beings gets nourished and thus help to
sustain the life of an individual.
 So it is concluded that the toxicity of modern medicines
can be countered by using only simple healing principles of
Ayurveda.