ROLE OF UNANI SYSTEM OF MEDICINE IN THE MANAGEMENT OF

HEART FAILURE- M.A.Lateef

SiddiquiHouse Surgeon,

Govt. Nizamia General Hospital,Hyderabad

• A 60 year old male is complaining of discomfort on exertion, cough, indigestion, increased urination during nights and fatigue.• He is a known Hypertensive, since 10 years.• He is a Chronic Smoker• No H/o Diabetes Miletus

What may be the cause???

• He might be suffering from initial stage of Heart Failure…

• And he can be easily managed with

Unani System of Medicine!!!

What is Heart Failure?

• Heart failure is defined as a pathophysiological condition in which the heart is unable to pump out sufficient amount of blood into circulation at a rate that meets the requirements of metabolizing tissues for oxygen and substrates despite the venous return to heart is either normal or increased.

• About 5 million Americans have heart failure.

• 5,00,000 new cases every year.

• 25-50 billion dollars a year to care for people with HF.

Incidence

Aetiology

• Depending on the origin it is divided into two types CARDIAC CAUSES (where the lesion is in the heart) NON CARDIAC CAUSES (due to increased work load)

• Almost all forms of heart disease may lead to heart failure.

Aetiology

Severe AnaemiaHypertensionHypoproteinaemiaBeriberiCor pulmonaleThyrotoxicosis

Cardiac CausesPericardialMyocardialEndocardial

Non Cardiac Causes

Risk Factors• Sedentary Life style• Hypertension• Diabetes• Obesity• Alcoholism• Smoking• Some infections

Patho-physiology• Cardiac Output = Heart Rate x Stroke Volume

• Heart Rate is Controlled by Autonomic Nervous System & Hormonal System

• Stroke Volume is maintained by Preload, Afterload and Myocardial Contractility

• Frank-Starling’s Law:The force of contractionof heart is directlyproportional to thedilatation of the muscle fibers beforethe onset of contraction

Patho-physiology

Decrease Cardiac Output

Decrease Blood Flow to organs

Decrease Renal Blood Flow

Activation of RAS

Vasoconstriction & Aldesterone Sec.

Salt & Water Retention

Oedema & Increase in Preload

Activation of Sympathetic

Increase in Heart Rate

Remodelling of Heart

End ResultFluid Overload – pulmonary and peripheral oedema

• Reduced Ventricular Contractility• Ventricular outflow obstruction• Ventricular inflow obstruction• Ventricular volume overload• Arrhythmia• Diastolic dysfunction

Mechanisms of Heart Failure

Types of Heart Failure

Heart Failure

Depending on Time Depending on part

involved

Acute Chronic Left sided Right sided Biventricular

Types of Heart Failure

Acute and Chronic Heart Failure:• Heart Failure may develop suddenly, as in Myocardial Infarction

known as Acute Heart Failure.

• It may develop in a gradual manner, as in Progressive Valvular Heart disease known as Chronic Heart Failure.

• In chronic, a variety of compensatory changes may took place which although initially improve cardiac function, but as the disease progresses they often become harmful.

Left, Right and Biventricular Heart Failure:• There is reduction in the Left Ventricular output and increase in Left

atrial or pulmonary venous pressure then it is Left sided Heart Failure.

• There is reduction in the Right Ventricular output and increase in Right atrial pressure and systemic venous congestion, then it is Right sided Heart Failure.

• Failure of Both Left and Right sided Heart is Biventricular Heart Failure or Congestive Heart Failure

Types of Heart Failure

Clinical Features

• Signs and symptoms• Dyspnea• Orthopnea & PND • Fatigue• Confusion • Anxiety• Tachycardia• Pulmonary Rales

Clinical Features

• Signs and Symptoms• Fatigue, weakness, lethargy• Weight gain• Increase abdominal girth• Anorexia• Peripheral&Dependant

Oedema• Elevated JVP• Hepatomegaly

Clinical Features

American Heart Association has classified Heart Failure into 4 stages• Stage A: No limitation of Physical Activity, ordinary physical activity does not cause any discomfort • Stage B: Slight limitation of physical activity, comfortable at rest, but ordinary activity causes fatigue, palpitation, SOB.• Stage C: Marked limitation of physical activity, comfortable at rest. Less than ordinary activity causes fatigue, palpitation, dyspnoea. • Stage D: Inability to carry on any physical activity without marked discomfort. Symptoms of heart failure may be present even at rest. If any physical activity is undertaken, discomfort is increased.

Classification of Heart Failure

• Chest X-Ray• ECG• 2D Echo• TMT• Arterial Blood Gases• Cardiac Troponins• Serum Electrolytes

Investigations

• Serum Creatinine• Blood Urea Nitrogen • Lipid Profile• Thyroid profile• Blood Sugar Test

Chest X-Ray

Normal Pulmonary Oedema

Bronchial Asthma Pneumonia Pleural Effusion Renal Failure Hepatic Failure

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Differential Diagnosis

• Adequate BP control• Adequate Diabetes control• Weight Maintenance• Cessation of Smoking and Alcohol• Lipid management• Use of Cardiotonics• Diet Restrictions• Appropriate Exercise

ManagementGeneral Measures for Stage A & B

ManagementThrough Unani Medicines for Stage A & B

Decoction (cardiotonic as well as lipolytic)• Gul e Banafsha (Viola odorata)• Gul e surq (Rosa Damascena)• Gul e Chambeli (Jasminum sambac)• Badranjboya (Nepeta Cataria)• Arjun Chaal (Terminalia arjuna)• Darunaj Aqrabi (Doronicum hookeri)• Abresham Maqraz(Bombyx mori coccoons)• Ushba Desi (Hemidesmus indicus)• Majeeth (Rubia cordifolia)• Darcheeni (Cinnamomum verum)

ManagementThrough Unani Medicines for Stage A & B

Along with Decoction some compound drugs like• Khameera Abresham Hakeem Arshad wala• Khameera Marwareed Khas• Khameera Gauzaban Ameri• Qurs e Jawahar Mohra• Dawa ul Misk Motadil• Tiryaq e Arba

ManagementThrough Unani Medicines for Stage A & B

For Diuresis we can give powder of • Tuqm e Kasni (Cichorium intybus)• Khar qasak (Tribulus terrestris)• Tuqm e Qayareen (Cucumis sativus)• Kaknaj (Physalis alkekengi)• Badayan (Foeniculum vulgare)Along with Arq e Kasni, Sharbat e Bazoori, Majoon e Dabidul Ward.

ManagementThrough Unani Medicines for Stage A & B

Dietotherapy:• Low salt diet (between 3-5gm)• Low fat• Rich in fruits and vegetables like Papaya, Pine apple,

Pomegranate, Guava, Apple, Bitter guard, Beans etc.

ManagementIn Stages C

We can continue, but with symptomatic treatment and Modern medicines like Nitrates, Digitalis, ACE inhibitors etc.

In Stages D

Heart Transplantation and other surgical interventions are required.

In Emergency Condition…

If Person is Literally Drowning into Secretions,Immediate action is neededUpright Position and Nitrates…

• Heart failure is common problem in elderly with bad prognosis if not diagnosed and managed properly with in appropriate time.

• Our primary goal should be to diagnose it as early as possible.• Clinical diagnosis can be confirmed by lab test and echo.• Start using cardiotonics and other Unani drugs.• Initial stages can easily managed with Unani system of medicine.• Fluid volume and vital signs should always be monitored.• By doing early diagnosis and proper management we can reduce

this burden from Humanity.

Take Home Message

• Start using as much fruits as possible• Start using honey• Avoid Junk Foods• Take meals at regular times• Do regular exercise• Avoid stress• Maintain normal Sleep

Take Home MessageTo prevent from Heart Diseases…

Wishing Healthy Heart , Healthy Life ....