N 3

1. N 3 Name: AA 60 yrs. Male Architect K/C/O: I.H.D, H.T & D.M C/O: Sudden CHEST PAIN with perspiration & Dyspnoea 2nd episode since last 6 months Diagnosed as A.M.I. WITH C.C.F. WITH ARRYTHMIA All cardiac enzymes increased ECG showing global infarct Atrial fibrilation Ejection fraction 20% Hb – 8.9mgm % P.A.P. – 40 B.P: 100 systolic: H.R 150/min ANGIOGRAPHY shows TRIPLE VESSEL disease. Kellipies classification Gr. IV survival chances around 10%

2. Rx. Given POOR RESPONSE TO THROMBOLYTICS MYOCARDIAL DEPRESSION AND CARDIO GENIC  SHOCK ALREADY ON NITROGLYCERINE & ANTIARYTHMIC AGENTS  IN ADEQUATE RESPONSE LAST RESORT INTRAAORTIC BALLOON PUMP FOR MAINTAINING THE CORONARY FLOW AS WELL AS PRESSURE STILL KEEPS GETTING ANGINA AND ARRYTHMIAS General condition  Exhausted & V. Poor Cardiac Surgeon refuses to take him on table.

3. BEHAVIOUR DURING ANGIOGRAPHY • CHILD LIKE BEHAVIOUR • EXTREMELY UN COOPERATIVE • ANXIETY3 & FEAR3 OF DEATH • CONSTANTLY ASKING WHETHER EVERYTHING WOULD BE OK • DUE TO ANXIETY THERE WAS ACUTE ANGIOSPASM WHICH WAS DEMONSTRATED IN ANGIOGRAPHY • REFUSED ANGIOPLASTY ON THE TABLE AND HAD TO BE TAKEN BACK TO ICCU

4. INTERACTION WITH PATIENT IN I.C.C.U • Cardiac Status Same • Talks to physician about resuming work  “Nothing has happened to me” • Denies fears & says nothing is wrong with me and then suddenly says that “My mother died on the opposite table in the same hospital” • Never removes the left hand from the heart • Lt. chest pain with back pain • Constantly denies anxiety and fear of death but wants you to be near and never leave him alone. • Feels unsafe in hands of doctors and not sure whether they will be able to handle him Observation: Flat expressionless depressed face with fear struck eyes exhausted look

5. BACK GROUND • Extremely conscientious (Russian Conscience) • Meticulous (British Meticulousness) • Cautious (American cautiousness) • Hardworking self made man • Conflict with father  Left house • Conflict with only son  Staying separate • Sharp and critical in judgment • Always pushes himself hard than what he can do • Indian by sentiments and relationships  • Always wanting to help the good cause in his own way • Virgin track record  fears blemishes

6. CURRENT TOTALITY • FEAR OF DEATH HEART SYMPTOMS DURING • FEAR FAILURE OF • SELF DECEPTION • OCCUPATION DESIRE FOR • MISTRUST ON SURROUNDING  THINKS THEY WILL HARM HIM • HOLDS HAND OVER HEART • DEVELOPED MURMER  AS CORDEA TENDINEA WERE FIRED

7. Remedy : NAJA 200C • A single dose of Naja 200C resolves the arrhythmia, blood pressure improves and pulmonary arterial pressure improved • Patient taken up for Cardiac Bypass surgery • Post-surgery, one more episode of arrhythmia with fall in blood pressure not responding to conventional drugs, Surgeon repeats one dose of Naja 200C

8. After recovery from surgery, chronic treatment continued. • AURUM ARS is the indicated chronic constitutional remedy • Low to moderate susceptibility indicated a 30C in infrequent doses • Patient improves to such an extent that he now attends work regularly and travels alone frequently.

9. NAJA expression in Cardiac Conditions: • LOCATION: • HEART • BLOOD VESSELS • VALVES • NERVES • PATHOLOGY: • ISCHEMIA & NECROSIS OF MYOCARDIUM • MYOCARDIAL DEPRESSION

10. A/F: ILL EFFECTS OF GRIEF - ANTICIPATION General Sensation Modalities: Sharp Neuralgic Radiations Constricted Feeling Drawn up feeling Intense burning Exhausted – as if intoxicated Screwed up Sensation Severe pain v/s Insensibility < Lying on Lt. side < After sleep < After Menses < Cold Draft < Alcohol > Smoking > Riding

11. Location & Organs Pathogenesis Nerves – Heart (Mitral Valve) – Respiration & Throat Cerebellum Medulla Myocardium, Blood vessels Lt. sided, Head and ovaries Ischemia – Infarct Oedema – Hyertrophy Failure, Collapse, Arrythmia, Sepsis of Vital organs Irritation/Inflammation Nerves Clinical Conditions Cardiogenic ShockHeadache Ovarian Neuralgia Intercostal Neuralgia Angina pectorls Cardiac Failure RHD Cardiac Arrythmia