Utility of Heart chapter of Murphy’s Repertory in Cardiovascular disorders

Dr Sreeja L

ABSTRACT
Cardiovascular disease comprises the most prevalent serious disorder in industrialized nations and are rapidly growing problem in developing nations. Patients with valvular heart disease or idiopathic dilated cardiomyopathy,by contrast may have a prolonged course of gradually increasing dyspnea and other manifestation of chronic heart failure. Understanding the natural history of various cardiac disorders is essential for applying appropriate diagnostic and therapeutic measures to each stage of the condition, as well as for providing the parents and family with the likely prognosis¹. In this article an attempt is made to trace out the utility of chapter ‘heart’ from murphy’s repertory in various  cardiovascular disease

KEY WORDS : Murphy’s repertory,Heart,Cardiovascular disease

INTRODUCTION
Cardiovascular disease(CVD’s) are a group of disorders of the heart and blood vessels. Cardiovascular disease are the leading cause of death globally. Most cardiovascular disease can be prevented by addressing behavioural risk factor such as tobacco use,unhealthy diet,obesity,physical inactivity and harmful use of alcohol. An estimated 17.9 million people died from CVD’s in 2019,representing 32% of all global death.Of these deaths,85% were due to heart attack and stroke³. The growing prevalence of obesity,type 2 diabetes mellitus and metabolic syndrome which are the important risk factor for atherosclerosis .Cardiovascular disease was considered to be more common in men than in women¹.

Classification of cardiovascular disease as Vascular disease and Heart disease

• Vascular disease such as Coronary artery disease, Peripheral arterial disease, Renal artery stenosis,Aortic aneurysm
• Heart disease such as cardiomyopathy, Hypertensive heart disease, Heart failure, Pulmonary heart disease, Cardiac dysrhythmias, Endocarditis, Inflammatory cardiomyopathy,Myocarditis,Vascular heart disease, Congenital heart disease, Rheumatic heart disease²

Common symptoms of cardiovascular disease:

• Chest pain,chest tightness,pressure and discomfort (angina)
• Shortness of breath
• Pain ,numbness,weakness or coldness in your legs or arms
• Tachycardia or bradycardia
• Dizziness or fainting
• Edema²

Many patient with cardiovascular disease may be asymptomatic both at rest and exertion but may present with abnormal physical findings such as heart murmur,elevated arterial pressure ,abnormality of the electrocardiogram or imaging test.it is important to assess the global risk of CAD in asymptomatic individual using a combination of clinical assessment and measurement of cholesterol and its fraction as well as other biomarker such as C reactive protein¹ it is important to detect cardiovascular disease as early as possible so that management with counselling and medicines can begin³.

Homoeopathy is very useful in treating the cases of cardiovascular diseases by the help of many repertories,among those the most important repertory is Murphy’s repertory which has a separate chapter as ‘Heart’ which consists of important rubrics such as Aneurism, Angina pectoris, Congestive heart failure, Dilatation, Endocarditis ,Fatty degeneration, Heart attack, Inflammation,Murmurs,Myocarditis,Palpitations,Pericarditis etc,which is  systematically arranged with more number of medicines for the purpose of repertorisation

HOMOEOPATHIC MEDICAL REPERTORY

• Author : Robin murphy
• A modern alphabetical repertory mainly based on kents repertory and knerr’s repertory
• Year of publication: 1993
• Editions:1st edition – 1993

2^nd edition – 1996

3^rd edition – 2009

The Homoeopathic Medical Repertory was designed to be a modern practical and easy to use reference guide to the vast homoeopathic Materia medica. This was done by giving the highest priority to find clinical information relevant to modern homoeopathic practice.In modern terms,the repertory represents the clinical and research database for the practice of homoeopathic medicines.The general information contained in these books is derived from history,provings,clinical practice,research,physiology and toxicology⁵

IN MURPHY-HEART CHAPTER

• The chapters and rubrics are arranged alphabetically
• 283 main rubrics are given starting with a rubric of Heart general then arranged alphabetically from ‘Aching’ to ‘Wounded’ along with sub rubric in alphabetical order
• Rubrics are well systematically arranged with more number of medicines for the purpose of repertorisation
• Important main rubrics are  Anemia, Aneurism, Angina pectoris, Congestive heart failure, Dilatation,  Edema, Endocarditis , Fatty degeneration, Heart attack, Heart beats, Hypertrophy, Inflammation, Menopause,at,heart troubles, Murmurs, Myocarditis, Pain, heart, Pain, region of heart,Palpitations, Paralysis, Pericarditis, Rheumatism, Systole extra,Valvular heart disease etc

Application of heart chapter in various cardiovascular disease can be understood by the following rubrics under each contents such as

• Clinical condition rubrics
• Type of pain rubrics
• Subjective sensation rubrics
• Location and sides rubrics
• Ailments from rubrics
• Modality rubrics
• Constitution rubrics
• Concomitant rubrics
• Unique rubrics

CLINICAL CONDITION RUBRICS

1) Arteritis

• It refers to inflammation of arteries that damages the blood vessels walls and reduce blood flow to the organs
• Arteritis can develop in many conditions such as
• Takeyasu’s arteritis : it is also known as aortic arch syndrome.it is characterised by inflammation of the walls of aorta and its upper branches
• Giant cell arteritis :it is an infection of the superficial temporal artery and the other arteries supplying blood to your head,eyes and jaw
• Polyarteritis nodosa : it is also known as kussmaul disease.it is an inflammation of the medium and smaller arteries that carry blood from heart to other organs and tissue

2. Congestive heart failure

• It is defined as a state in which the ventricles at normal filling pressure cannot maintain an adequate cardiac output to meet the metabolic needs of peripheral tissue or can do so only with an elevated filling pressure

Conditions :

• Valvular disease such as mitral valve prolapse,bicuspid or tricuspid regurgitation
• Atrial myxoma
• Pericardial disease
• Hypertrophic cardiomyopathy
• Severe hypertension
• Acute coronary syndrome complicated by pulmonary edema
• Acute kidney injury
• Goods pasture syndrome
• Chronic obstructive pulmonary disease
• Bacterial pneumonia

3. Deposits on endocardium

• Deposits on endocardium occurs in case of :
• Carcinoid valve disease : it is characterized by the plaque like endocardial fibrous tissue deposits primarily affecting the right  heart endocardium and valves which results as a consequence of the disease process
• Cardiac amyloids :it is a disorder caused by deposits of an abnormal protein in the heart tissue
• These deposits make it hard for the heart to work properly
• Cardiac calcification

4. Dilatation – hypertrophy of Heart

• Cardiac hypertrophy is the thickening of the heart muscles refers to the compensatory hypertrophy of the ventricular myocardium due to physiological or patho-physiological events

Conditions :

• Left ventricular hypertrophy
• Hypertrophic cardiomyopathy
• Hypertension
• Aortic stenosis
• Amyloidosis
• Athlets heart
• Glycogen storage disease
• Fabry disease
• Sarcoidosis

 5. Inflammation

• Inflammation is a process by which it initiates the body’s defence mechanism and plays a role in the healing process in response to harmful stimuli such as pathogens.irritants involving immune cells,blood vessels and molecular mediators
• Inflammation in heart can occur as Endocarditis,myocarditis,pericarditis
• Endocarditis is inflammation of the inner lining of the hearts chamber and valves

Conditions of endocarditis  :

• Infective endocarditis
• Systemic lupus erythematosus
• Cardiac neoplasm
• Reactive arthritis
• Tricuspid regurgitation
• Septic pulmonary infarction
• Myocarditis: it is the inflammation of the middle layer of the heart wall

Conditions:

• Viral infection
• Common cold(adenovirus)
• COVID19
• Hepatitis B and C
• Gastrointestinal infection
• Mononucleosis
• Rubella
• HIV

Pericarditis : it is an inflammation of the pericardium,it usually develops as acute,suddenly last up to several months

Conditions:

• Viral pericarditis
• Bacterial pericarditis
• Fungal pericarditis
• Parasitic pericarditis
• Systemic lupus erythematosus
• Rheumatoid pericarditis
• Uremic pericarditis
• Genetic disease such as familial Mediterranean fever
• Idiopathic pericarditis

6) Palpitation

• Palpitation make you feel like your heart is beating too hard or too fast,skipping a beat or fluttering

• Conditions

CARDIAC	NON CARDIAC
Atrial fibrillation	Alcohol
Atrial myxoma	Anemia
Atrioventricular tachycardia	Beta blocker withdrawal
Cardiomyopathy	Caffeine
Valvular heart disease	Fever
Ventricular tachycardia	Pregnancy
Sick sinus syndrome	Thyroid dysfunction

7) Edema

• Edema is swelling that is caused by fluid trapped in your body’s tissue
• Edema happens most often in the feet,ankles and legs but can affect other parts of the body such as face,hands,abdomen

Conditions:

• Congestive heart failure
• Acute and chronic kidney disease
• Nephrotic syndrome
• Myxedema in hypothyroidism
• Right heart failure
• Portal hypertension
• Allergies
• Acute respiratory distress syndrome 

   8) Murmur

• A Heart murmur is an extra sound that the blood makes as it flows through the heart
• 3 types of murmur : Systolic, Diastolic and Continuous murmur

Conditions of systolic murmur

• Aortic stenosis
• Pulmonic stenosis
• Mitral regurgitation
• Tricuspid regurgitation
• Mitral valve prolapse
• Atrial septal defect
• Ventricular septal defect

Conditions of diastolic murmur

• Aortic regurgitation
• Pulmonic regurgitation
• Mitral stenosis
• Tricuspid stenosis
• Austin flint murmur
• Continous murmur
• Patent ductus arteriosus

9) Weak heart

• When heart is weak it is unable to pump enough blood to meet the body’s need

Conditions :

• Diabetes mellitus
• Coronary heart disease
• High blood pressure
• Cardiomyopathy
• Congestive heart failure
• Obesity
• Smoking

10) Angina

• Angina is a type of chest pain caused by reduced blood flow to the heart

    Conditions

• Cardiovascular – Pericarditis, Myocarditis, Hypertrophic Cardiomyopathy, Aortic stenosis, Acute coronary syndrome, Aortic dissection
• Pulmonary – Pleuritis, Asthma exacerbation, Pneumonia, Pulmonary embolism, Pulmonary hypertension ,Lung cancer
• Gastrointestinal – GERD, Esophagitis, Esophageal spasm, Gastritis, Peptic ulcer disease
• Bones – Rib fracture, Costochondritis

9) Fatty degeneration of heart

• It is a retrogressive condition in which fat droplets are found in the myocardial sarcoplasm

It is usually secondary to such condition as

• Myocarditis
• Pericarditis
• Coronary arteriosclerosis
• Myocardial insufficiency
• Starvation
• Anemia

10) Polyp,heart

• The myomas are usually polyps frequently located in the region of the left auricle with their base in the region of the fossa ovalis
• These polyps are often pedunculated and may reach the size of an egg or more

      Conditions :

• Papillary fibroclastoma
• Lipoma
• Rhabdomyoma
• Thrombus or emboli
• Cardiac metastasis

    11) Heart beat in general

• Abnormal- Arrhythmia, Coronary artery disease, Abnormal heart valves, Cardiomyopathy
• Bounding – Paroxysmal supra ventricular tachycardia
• Dull- Cardiac arrest and Shock
• Diminished – CAD,alchohol use,sleep apnoea,high BP
• Fluctuation – arrhythmia,premature ventricular contraction
• Imperceptible – cardiac arrest and shock
• Increased -anemia,imbalance electrolyte,hyperthyroidism,stress

   13) Heart attack

• Myocardial infarction commonly known as a heart attack occurs when blood flow decreases or stops to a part of the heart causing damage to the heart muscles

        Conditions :

• Pulmonary embolism
• Myocarditis
• COPD
• Aortic regurgitation and Acute mitral regurgitation

  14) Valvular heart disease

• Valvular heart disease is when any valve in the heart has damage or is diseased
• Valvular disease are regurgitation and stenosis

        Conditions

• Aortic valve stenosis
• Mitral valve stenosis
• Tricuspid valve stenosis
• Pulmonary valve stenosis
• Mitral regurgitation
• Tricuspid regurgitation pulmonary regurgitation
• Rheumatic heart disease
• Congenital heart valve disease

TYPE OF PAIN RUBRICS

• Aching
• Boring
• Burning
• Bursting
• Burrowing
• Catching
• Constricting
• Dragging
• Gnawing
• Sharp
• Shooting
• Spasmodic
• Radiating
• Tearing
• Vise pain
• Twisting
• Twitching

SUBJECTIVE SENSATION RUBRICS

• Adhesion sensation
• Ball heart as of
• Boiling in heart region
• Break as if something to regions of heart
• Buzzing sensation
• Cold feeling of heart
• Coldness,feeling in heart region
• Crushing sensation
• Dragging sensation
• Floating sensation
• Fluttering sensation
• Large sensation as if too
• Pressed sensation in as if towards the heart
• Restless feeling in heart
• Smothered heart as if
• Wood in between heart and lungs as if
• Wounded feeling of heart
• Thread suspended by as if heart
• Vaccum as if heart is beating in

LOCATIONS AND SIDES RUBRICS

• Aorta
• Heart in general
• Mitral valve
• Myocardium
• Right of,with venous stagnation
• Tricuspid

AILMENTS FROM RUBRICS

• Infectious disease after
• Nephritis after heart complaints
• Strepycoccal infection,heart complaints after
• Tobacco heart

MODALITY RUBRICS

• Anger agg heart complaints
• Ascending stairs agg heart complaints
• Bending and heart complaints
• Busy being amel,heart complaints
• Exertion heart compliants after
• Sighing amel heart compliants
• Waking heart complaints on
• Walking heart complaints

CONSTITUTION RUBRICS

• Chronic heart complaints,in young girls ,from over lifting
• Elderly people heart complaints in
• Menopause period with heart complaints
• Scrofulous constitution in heart complaints

CONCOMITANTS RUBRICS

• Cough,heart affections with
• Eyes amblyopia with heart disease
• Hysteria heart derangement with
• Indigestion with in functional heart symptoms of elderly people
• Larynx,cardiac derangement with nervous aphonia
• Liver fatty degeneration as sequel of heart disease
• Lung complaints with heart problem
• Menses amenorrhea and menorrhagic symptoms with heart problems
• Neuralgia with heart complaints
• Rheumatism heart complaints with
• Trachea irritation secondary to heart disease
• Typhoid symptoms with heart complaints

UNIQUE RUBRICS

• Circulations
• Conscious of heart feeling
• Contraction increases
• Ear noises in synchronous with heart beats on sitting up
• Hands held over heart
• Irritable heart
• Movement heart of
• Percussion sound,dull sound over large surface at base of heart
• Qualmish feeling with nausea and accumulation of saliva
• Systole extra
• Tension heart
• Tonic for heart complaints
• Water as if cold drops falling from heart
• Water as if working in with palpitation
• Wave like motion not synchronous with pulse⁶

CONCLUSION

Homeopathic medical repertory is based on the principles of clinical as well as classical homoeopathic practice.This repertory merges both kinds of practice unlike many other repertories and it has the advantage of meeting the requirement of various types of cases.The authors aim to make it a modern,practical and easy reference book has enriched this repertory with many clinical as well as pathological rubrics.This is a unique repertory which helps a practitioner to find out the similimum on the basis of clinical as well as classical symptoms⁴

REFERENCES

• Longo, Fauci, Kasper, Hauser, Jameson, Lascalzo. Harrison’s Principles of Internal Medicine.18^th. USA: Mc Graw Hill Company
• Google:https://www.mayoclinic.org/diseaseconditions/heartdisease/symptos-causes/syc-2035118
• Google:https://www.who.int/news-room/factsheets/detail/cardiovascular-disease-(cvds)
• Shashi kant Tiwari,Essentials of Repertorisation,Published by B Jain Publishers.5/e.2012
• Shanu Salim.Ginu D Mohan,Genesis D M D,Repertory Expert A New Experience on Understanding Repertories,Published by Dr SALIM’s Center for Homeopathic Healing 1/e.2020
• Murphy R.Homoeopathic Medical Repertory. B jain publisher (P) LTD; 3/e. 2016

Dr Sreeja L
MD Part 2
Department of Case taking and Repertory
Under the guidance of  Dr Anusuya M Akareddy
Government Homoeopathic Medical College and Hospital, Bengaluru