By Mr. Pushpa Raj Poudel,
Introduction
Coronary artery diseases are the major contributor to the premature mortality and morbidity.
Nowadays it is spreading as epidemic problem in the world causing more loss.The trend of CAD from western country shows the declining rate of its incidence dueto prompt improvement in public awareness. Even though in Uk 1 in every 3 men and 1 in every 4 women die from coronary hert disease. 12 million death annually and is commonest cause of death globally.
Due to blind changing in daily activities in the name of modernization in developing country it is alaraming now.
In Nepal in between 1960-1968 AD 150 cases of myocardial infarction are admitted in the hospital. But now it is increased by fourfold and becoming second common heart disease after Rheumatic heart disease.
By the year of 2020 it is estimated that it will be the major cause of death in all regions of the world.
Risk factors for the coronary artery disease which can’t be changed are:
1. Increasing age- Over the 83 percentage of the people die from CAD are their sixties by age.
2. Sex - men are more prone to CAD than women even after their menopausal age.
3. Heredity -Atherosclerotic vascular disease like pattern running in the family are at increased risk of CAD.
Factor that can be modified by adopting hygienic lifestyles are
1. Tobacco – smoker are 2to 4 times more risk than non smoker. Cigarette is powerful independent risk factor for the sudden cardiac death.
2. High Blood cholesterol- total Plasma cholesterol level more than 170mg/dl are at increased risk.
3. Physical activity - sedentary, office working and business dealing who doesn’t brisk walk one to 2 kilometers or doesn’t indoor aerobics exercise per day is at greater risk to likely suffered from CAD
4. Obesity – Body mass index greater than 30 are more prone to CAD. Truncal obesity is independent risk factor.
5. Diabetes mellitus- Glucose intolerance accounts for a major part of the high incidence of ischemic heart disease in certain ethnic group.
6. Stress - recent study shows that there is some association between increased stress on daily activities to CAD
7. Alcoholism- who drinks alcohol more than 4 units per day likely to die from CAD.
8. Haemostatic factor- Platelet activation and high levels of fibrinogen are associated with increased risk of coronary thrombosis. Anti phospholipid antibodies are associated with recurrent arterial thromboses.
9. Other dietary factors-Increased intake of saturated fat, deficient Vit. C and E are at increased risk.
10. High blood Pressure- Atherosclerosis is more associated with HTN.
11. Personality traits –Certain personality traits are associated with an increased risk of coronary diseases.
Absolute risk factors
A man of 35 years with plasma cholesterol of 170 mg/dl who smokes 40 cigarette /day is relatively much more likely to die from coronary diseases within the next decade than a non smoking woman of the same age with normal cholesterol.
Patho-physiology of Coronary artery disease
Coronary artery disease and ischemic heart disease are quite interchangeable terms. Coronary artery disease mainly due to:
1. Coronary Atherosclerosis- More than 90% changes by atherosclerotic, in left anterior descending artery.
2. Superadded changes in coronary atherosclerosis e.g. Atheromatous plaque, thrombotic, platelet aggregation and coronary artery spasm due to vasospasm mediator thromboxaneA2.
3. Non - Atherosclerotic-10% coronary changes by following factors:
Vasospasm, stenosis of coronary ostia, s no any compensatory mechanism works. In this way Myocardial infarction happens if medical seeking is not promptly done and leads to subsequent death.
Coronary disease and recent advances in Ayurveda:
Time tasted medicine, Ayurveda is going to extend its branches by challenging the most world epidemic burden, Coronary artery disease even in this era. Here, Sir Sundarlal hospital of the Banaras Hindu University’s Ayurvedic wing did this attempt. This task is done by the team of Emeritus Prof. Dr. Ramharsha Singh and Ph.D. schoolar Dr. Pratibha Mamagain. As per the treatment Protocol provided in the ancient classical text, they used the Lekahaniya (Bulk reducing) gana of the Charaka samhita i.e. Guggulu (Commiphora mukul), Arjuna (Terminalila chebula),Vacha (Acorus calamus) etc. The successful results of this event lead them to establish the Coronay wing in the ayurvedic hospital.
Material and Methods of Research
For this deed they selected the 45 patients from their own OPD and admitted of age between 30-60 years of both male and female, of complaining Precordial chest pain, dyspnoea on effort, palpitation, Giddiness, headache, constipation, joint pain, pallor, known patients of Hypertension, Diabetes mellitus.
Patients had the coronary prone behavior pattern and hyperlipoproteinmic pattern. Ischemic changes were present in all cases. Of them six cases were also had MI changes and of them 60%were urban background and rest of all belongs to villagers nearer to Varanasi. The ratio between male and female was 2:1.
They confirmed the patients of the coronary artery diseases by investigating the serum cholesterol, triglycerides and reading the ST elevation in the ECG means using the Ponderal index and
Ateherogenecity index.
Excluding the lung pathology they were divided into three groups of each fifteen control, standard and trial by using guggulu as standard and vacha (Bojho) as trial drug. For this purpose they made the tablet of each 500mg and given them for three months daily thrice a day with other symptomatic medication.
After the course of this medication analyses regarding symptomatic and serological changes were recorded.
Regarding to our own ethics they all were belong to Medasar purusha (in totality increased BMI), Kaphaja, Vatakaphaja, Pittakaphaja prakriti (Psychosomatic status) and in the pathogenesis of Medavaha srotas Vyapad stage.
Results of this Research:
Serum cholesterol changes in comparison to standard and placebo by trial drug
• Standard group – fall was 53.4mg% from initial 230mg%
• Trial group - fall was 58.67mg%from initial over 250mg%
• Control group - fall was 8.53mg% from initial over 220mg% after the three months course of medication.
Serum Tryglycerides changes
• Standard group- fall was25.3mg% average in the 86mg%
• Trial group - fall was41.6mg% in the 96.6mg%of initial
• Control group - fall was 8.33mg% in the initial of 120.7mg%
Pattern of rise of serum HDL
• Marked increased by trial drug (vacha) from 35.06mg%to 53.06mg% which was more significant than others.
Mean reduction of serum very low density Lipoproteins
• Reduction was 69.53mg% in initial of the 187mg% when treated by trial drug which was more than rest of standard and control.
On the basis of symptoms improvement
• 53.5% patients got complete relief from in chest pain
• 40% patients got complete relief from dyspnoea.
• Rest of all showed some level of symptoms improvement
Findings on ECG
Majority of the patients did not show any changes in their ECG tracing.In control group one cases showed improvement. In standard group one case showed significant improvement and two showed improvement while in the trial group one showed significant improvement and three showed improvement.
At the last of the treatment patient profile of all these parameters showed that there is significantly increased Ponderal index and decreased Atherogenecity index. From the Casdorph proposition (1971) the serum cholesterol and tryglycerides are the two pathogenic for IHD if they are lowered then reversible condition occurs means the formation of the atheroma is checeked. That’s why it is concluded that Vacha is effective for the management of the Coronary artery disease in ayurveda. So, the system practicing from the time immortal is equally valuable as modern system of medicine.
Research done in Patanjali Yogpeeth, Hardwar:
Effect of yog and Pranayam on Heart Patient (ECG) test
110 patients were tested for ECG before beginning yog treatment. Out of which 50 patients were abnormal,which were tested again after the camp. Of them35 patients were selected for analysis of results and the rest were excluded due to the technical problem.
The results showed that there was significant improvement in braducardia, tachycardia,ST changes and arrhythmia level.The ECG of LBH RBBB and LBBB did not show any improvement.
Effect of yog and Pranayam on Lipid profile
1,080 patients were selected to study the lipid profile. The test for total cholesterol,HDL,LDL,VLDL and Tryglycerides were done before and after camps. As per international standards the total cholesterol,HDL,LDL,VLDL,and Tryglycerides showed 62,65,39,and62 percents improvement.
Dr. Dean Ornish Program for Reversing Heart Diseases: Synergistic Achivements
It is becoming more popular in hurricane speed in western medical sciences by bypassing the Bypass surgery to adopting the some yogic regimens like Yoga for integrating the Balance between Body, mind and soul, sattwik diet(more compatible to the human body). In this program really after attending one can open his or her heart by quitting smoking ,alcohols,Unsaturated and refined fat,minimizing salt intake and marked changes in Negative thought to positive to reduce stress to become Joyfull for forever by reversing the condition like constricting and knife cutting chest pain i.e. Ischemic Heart Disease
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