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शुक्रवार, 19 फ़रवरी 2016

HCM and HOCM with Ayurveda perspective

HCM and HOCM with Ayurveda perspective ; 

Hypertrophic cardiomyopathy is characterized by non dilated left ventricular hypertrophy. Later there may be hypertrophic obstructive cardiomyopathy due to left ventricular outflow tract pressure gradient. Three basic mechanisms are involved ; (1) increased left ventricular contractility ( effect of prakupita kapha ), (2)- decreased ventricular volume (preload),( aadaana karma of praana vaayu is impaired ), (3)- decreased aortic impedance and pressure (afterload) -( vyaana vaata karma haani ) 2&3 are because of hridaya gata vaata ( angina pectoris , fatigue and syncope are present with dyspnea , a common symptom due to diastolic dysfunction/ impaired left ventricular filling indicate predominance of vaata Kaphaja hridroga with hridaya gat vaata can be considered in HCM and HOCM.. Hridayarnava rasa , chandraprabha vati , gokshuraadi guggula , kvaatha of combination of dashamoola arjuna punarnava gokshuru varuna haritaki devadaru pushkaramoola kamal shatavari ashwagandha chitraka vacha shunthi . Shaalaparni with milk. Kamadudha , arjunaarishta , hrida basti by dashamoolaadi tail or prepared as per ch.chi 26 vaatika hridroga..Advice for salt restriction , no physical and mental stress , no alcohal, no smoking , small bolus of food at a time 4-5 times per day. Pomegranate grape orange fig are good fruits .. Gandharva haritaki can be added at night for proper bowel motion to avoid straining during defaecation...Food intake increases blood suply to splanchnic circulation so demand is increased which in turn develops overload on failing ( compromised ) heart and manifests dyspnea fatigue giddiness chest pain... Its due to vaata prakopa in hridayashtha sthaan ie hridaya gata vaata. Anshumati sapayasaa is indicated by acharya charak...
I have elaborated 3 specific underlying pathology in HCM and HOCM with vaata predominace , but initial factor is kapha prakopa leading to non dilated cardiomyopathy , increased mass of myocardium , mass represents sthoola bhaava so its due to kapha , later contractility preload and afterloads are impaired . due to diastolic dysfunction dyspnea manifests , due to increased mass demand for O2 is increased and that is not supplied adequately so there is imbalance between demand and supply leading to ischaemia and chest pain ie due to apatarpana vaata prakopa in hridaya so hridaya gata vaata can be considered.. decreased cardiac output (due to left ventricular outflow obstruction - sanga ) causes decreased effective arteriolar volume and renal hypoperfusion resulting in activated renin angiotensin aldosterone system to manifest salt and water retention vasoconstriction and remodelling of ventricle. These are consequences of disease process and can be considered as vitiated vaata to bring ambu dhatu to retain beneath tvaka and maansa ie edema.. treatment plan includes to work on 3 basics ; arjuna shatavari kakamachi ashwagandha for srength of contractility to maintain diastolic function. Punarnava gokshuru varuna to reduce preload and pushkaramoola dashamoola to maintain normal after load.. chitraka vacha trikatu to decrease sanga or obstruction.. hridayarnava rasa contains tamra and kaakamaachi so better option in this condition.. chandraprabhavati gokshuradi guggula to decrease congestion , gokshuru is hridya too. Kamadudha acts on action potential to provide normal ionic changes across cell membrane . Angiotensin 2 is potent vasoconstrictor( increases peripheral resistance) , increases sympathetic activity (increased cardiac output), secretion of arginine vassopressin so increase renal reabsorption of water , increase aldosterone secretion so promote salt and water retention( increase venous return so increased cardiac output )  hypertension.. salt is major cause of activated RAAS - pitta prakopaand rakta vriddhi. Kapha prakopa and dhamanipratichaya...HTN. Aamaashaya gata vaata manifests shvaasa , as pranavaha sroto dushti since pitta sthaana samudbhava is mentioned in shvaasa roga.. here shvaasa is one of symptom of HCM.
Hridaya as a whole organ is moola sthaana of prana vaha rasa vaha and rakta vaha.In dhamanipratichaya sakapha meda and maansa interplay to develop uplepana on dhamani .. it leads to avarodha of vaata gati.. it should not be considered as dhamanipoorana: In Aortic stenosis pathogenesis occurs similar to as that of atherosclerosis so modern dr advice statins in AS . CAD, AS and HCM are different disease entities .. but in AS and HCM angina pectoris is present without CAD , only due to increased demand caused by hypertrophy..

.Prof. Dr. Satyendra Narayan Ojha ,
MD (KC), Ph.D.
Director , Yashawant ayurveda college , Post graduate teaching and research center ,
Kodoli ,Panhala , Kolhapur..
 drsnojha@rediffmail. com

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