Arogyadhama

case presentation - B

Apoorva Singh (MSc YT – Sem 3)

Reg no. 1070820029
Introduction to the section

IP Number Therapists
2021/08/03/26 01 04 Bikash Kr. Purohit

Name Consultants
Komal 02 05 Dr R Nagarathna

Doctors In Charge Subsection

Dr Priyanka Nayak, Dr Harish Gopal 03 06 Cardiology
Section Introduction
Section B primarily deals with Cardiology and
Pulmunology and its related disorders. Its Aim
for Cardiology is to reduce peripheral resistance,
Inculcate IAYT for better functioning of
Cardiovasular sytem, Improve Quality of life,
Reduce Sympathetic arousal and give deeper
relaxation to vital organs
 Hypertension (HTN)
Systemic arterial hypertension is characterized by persistently high blood pressure in the systemic arteries. Also
called a silent killer – most people may have no symptoms.
(To diagnose for an individual check 3 days for 3 different intervals)

Primary Hypertension: No organic cause is found.

Secondary Hypertension: Causes: Renal causes, Endocrinal cause, Pre-eclampsia (High Bp during Pregnancy)

Classification : Mild Hypertension: 140-160/90- 100 mm/hg

Moderate Hypertension: 160-180/100-120 mm/hg
Severe Hypertension: > 180/100-120 mm/hg

Blood Pressure = Cardiac Output * Total Peripheral Resistance

Cardiac Output = Heart Rate * Stroke Volume
HTN affects body by adding more workload to heart and
arteries!

Risk factors
Obesity: BMI > 25 kg/mt sq., Stress, Air pollution, Smoking,
Family history of Hypertension, Diabetes mellitus,
Hyperlipidaemia

Causes
Obesity, Decreased cardiovascular fitness, hormonal
changes, rapid growth spurts, smoking, excess salt intake,
age factor and stress.

Signs and Symptoms

Generally asymptomatic. Symptoms include:
headache, breathlessness, dizziness, blurred vision,
palpitation, disturbed sleep, depression, anxiety,
nervousness, chest pain
Stress response system
Overstimulation ~ Cortisol level increases ~ Sympathetic
activation ~ Leads to vasoconstriction ~ BP Rises

Relaxation ~ Parasympathetic activation ~ Vasodilation ~ BP

reduces ~ Cortisol level decreases

Cardiac Cycle

Atrial systole – 0.1 secs

Ventricular systole – 0.3 secs
Complete cardiac diastole – 0.4 secs
HTN Pathophysiology
• There is still uncertainty about the pathophysiology of hypertension. Among the factors that have been intensively studied are

✓ Salt intake, The renin-angiotensin system

(Icrease Sodium → Increase in blood volume → increases BP →inhibits the renin angiotensin aldosterone axis → reduces
renin → reduces angiotensin II → reduces BP)

(Increase in Na → vasoconstriction → Increases peripheral resistance → increase BP)

✓ The sympathetic nervous system (ANS on Blood vessel, Adrenal gland and Heart)

✓ Cardiac output and Peripheral resistance (Diameter, length of vessel and viscosity of blood)

✓ Including genetics, vasoactive agents (Hypoxia – vasodilation, hyperoxia – vasoconstriction)

✓ Endothelial dysfunction (vasoconstrictor peptide endothelin → Increases BP)

✓ Low birth weight and intrauterine nutrition (Small at birth – tendency to be hypertensive adults)
General Line of Treatment

Complications :
CVA, CAD, Left ventricle failure, Retinal
complication, Subarachnoid Hemorrhage
Lifestyle Modification :
Weight loss, Physical activity, Salt
restriction, DASH diet, reduce alcohol
consumption

Investigation :
Sphygmomanometer
Medical management :
ECG, X Ray Diuretics: excess fluid is thrown
out of the body
Beta blockers : blocks the
activity of renin, which increases
the heart rate.
Vasodilators: dilates the blood
vessels
 Myocardial infarction - Commonly called as heart attack.
It is the damaging or death of an area of the heart muscle resulting from a blockage in the blood supply to
that area. Most common symptom is chest pain, nausea, shortness of breath.

Investigation : Chest X-ray, Electrocardiogram

(ECG), Echocardiogram, Cardiac catheterization
(angiogram).
01

Medication : Vasodilators (Nitrates)

Beta blockers (decrease workload in heart)
Calcium channel blocker (Improve coronary blood flow)
02
Opiate Analgesics (to reduce pain)

Surgery : Angioplasty and stent placement.

Coronary artery bypass surgery. 03
 MI Pathophysiology
Atherosclerosis – Cholesterol build up (Plaque) on coronary artery causes Ventricular
Hypertrophy, Primary coronary vasospasm etc.

Sudden reversible/Not reversible occlusion

|
Ischemia
|
Hypoxia
|
Reduced oxygen demand Angina
|
Thrombolysis Unstable Angina
|
Permanent thrombus → Necrosis → MI
 Case Writing

Provisional Diagnosis
01 Hypertension, Type 2 DM,
IP Number Myocardial infarction
2021/ 08/03/26
Name, Gender/Age
Ishwar Agarwal, Male/81
02
Date of Admission
24/08/2021
Marital status – Married
Date of Discharge
Education – 10th pass
Occupation – Retired, social worker 09/08/2021
Presenting Complaints
C/o Giddiness in the last 4 months
C/o Fatigue in the past 10 years
C/o Weakness for 4 months
C/o irregular bowel in the past 10 years
C/o bloating for 10 years
K/c/o Acidity for past 10-15 years
K/c/o prostrate enlargement for past 10 years
K/c/o Type 2 DM and Hypertension for past 6 months
K/c/o Myocardial Infarction for past 6 months
K/c/o High BP for 10 years
Also facing left ear hearing problem since 6-7 months.
 History of Presenting Complaints

January’21 March’21 Later Early days

Sudden unesiness, Giddiness Growing up had stress

Hospitalised for a week, Also diagnosed with
and sweating due to prolonged due to family, home
Advised complete bed Hupertension and Type 2
standing for vote. Diagnosed conditions and work
rest for 45 days. Diabetes mellitus.
with acute MI in march’21 environment which he
was unable to manage
 Personal details

Allergy History Hospitalization

Last week of
March’21
Dust Allergy hospitalised due to
uneasiness.
sometimes. Diagnosed with
Co-morbidity Anthropometry Stroke (MI), was in
Medication
ICU for a week

Height – 167 cm Currently on

Due to heart
condition, was Weight – 61.9 kg medication for
diagnosed with BP, DM and heart
BMI – 22kg/m sq condition (MI)
HTN, Type 2 DM
and High BP Waist – 34 inch
 Family history of Illness Addictions, If any Veg/Non-veg
Paternal – Old age heart condition None as of now, Consumed alcohol and Prefers vegan food only, Likes to
was a chain smoker for 10 years (1965- consume yogurt.
Maternal - None
75). Now only consumes tea twice a day.

Typical daily food Intake Weight gain/loss amount? Elimination Pattern

3-4 meals a day Due to heart condition lost 5-6kgs Bowel – Irregular (Constipated)
Typical daily fluid Intake Appetite?
Bladder – Normal in frequency
2-2.5 liters per day Poor/decreased, at time of admission
Sweat – Normal
 Personal details

Spare time activity Vital Signs Duration/Type of exercise

Meditation (ram chandra Pulse – 72 bpm
Light exercise in morning. 30
mission) – Provides distance Respiratory rate – 17 cpm
mins walk when possible
healing as seva to the NGO Blood pressure – 150/64 mmhg
 Sleep – Rest Pattern Stress History

At the time of admission, the participant had The participant had childhood (family and home
disturbed sleep. Usually gets 6.5 hours of conditions) and later work stress for 30 years.
sound sleep everyday. No problem initiating Now manageable but has affected his health
sleep. severely leading to Constipation, Heart
problems, Diabetes, Hypertension – all stem
from stress
Provisional Diagnosis

Hypertension
Myocardial Infarction
Type 2 Diabetes Meletus
 %
VARIABLES BEFORE YOGA AFTER YOGA CHANGE

Pulse (bpm) 72 61 15.27%

Respiratory Rate (cpm) 17 15 11.76%

Systolic BP (mm/hg) 150 138 8%

Diastolic BP (mm/hg) 64 72 12.5%

Breath holding time (secs) 17 22 29.41%

Weight (Kgs) 61.9 63.3 2.26%

Symptom score 2 0 100%

Medication score 15 13 13.33%

 Case Conclusion

01 Discussion 02 Conclusion
The participant had come to Prashanti with complaint of High With the change in diet along with additional practices of
BP, Type 2 DM and MI. he also had constipation issues, overall asana, pranayama, meditation, kriya, Ayurveda and
weakness and fatigue. He wanted to improve his lifestyle and Naturopathic treatment the participant showed significant
Naturally heal his body. In a span of 1.5 weeks the participant improvement in his overall health and parameters.
showed significant improvements.
With right Ahara, regular exercise, managing speed of mind
Among parameters, His BP normalised (Systolic BP reduced and healthy dincharya one can effectively manage present
signifying reduced arterial pressure), respiratory rate reduced health condition and overcome further complication. The
signifying increased lung capacity. Bhramari time increased by participant still struggles with bowel problem but overall state
29%, Had healthy weight at time of discharge. Symptom and of mind and Quality of life improved.
medication score reduced.
 Management Plan
AHAR – VIHAR – ACHAR - VICHAR KRIYAS
Right food, Recreation/Daily routine, Conduct with the Jala neti, LSP, trataka. Avoid Sutra neti, Vaman dhauti
external world and state of mind (goals in life) and Kapalbahti (overstimulation – can increases stress

K
and sensitivity)

V
D
ASANA
Loosening Practices Sukshma vyayama, breathing practise.
Chair practices and supine practices to reduce peripheral
A DIET MODIFICATION
Sattvic Vegetarian Diet to build immunity, Kapha
resistance and improve systemic circulation. reducing diet. Avoid salty, spicy and sugary foods and
AVOID – Shalabhasana, Mandukasana, Yog Mudrasana for consume whole grain, Low fat foods. DASH diet
Diabetes and Hypertension (Dietary approaches to stop hypertension)
 Pratiprasava
PRANAMAYA KOSHA VIJNANAMAYA KOSHA
Breathing Practices for better oxygenation and Yogic counselling, Satsang to get knowledge about self
circulation, increase tidal volume. and disease. Notional correction and lifestyle changes.
Nadi shuddhi proven to be effective with reducing blood
sugar levels.
Sectional pranayama, Bhramari and Nadanusandhan
effective.
P
M
V
MANOMAYA KOSHA
Bhajan for emotion culturing.
A ANANDAMAYA KOSHA
Happiness analysis, Tuning to nature, Selfless service .
FOCUS -> DEFOCUS accumulated stress. Realizing ones true nature ’Atman’.
MSRT, CM to give deep rest and relaxation to body.
Role of yoga in Cardiovascular disorders

Increased physical activity, reduced routine psychological stressors, and repeated practice of relaxation and breathing
practices which are known to reduce sympathetic activity by downregulation of hypothalamic-pituitary-adrenal axis.

Decreased sympathetic activity is associated with reduction in the BP and peripheral vascular resistance
and enhancement of BRS (Baroreflex sensitivity)

Yogic postures and sukshma vyama increase glucose uptake and reduce insulin resistance – Also reduces
low density lipoprotein, cholesterol and triglycerides.

Yoga may produce favorable effects through modulation of neuroendocrine-immunologic pathways. Cortisol levels
are positively associated with stress and anxiety and Yoga has been shown to reduce cortisol levels both in health
and disease.
THANK YOU