HYPERTENSION

1
KNOWLEDGE OF ILLNESS IN GENERAL KNOWLEDGE OF
DISEASE IN PARTICULAR
BRIEF REVIEW
2

• Aphorism 1
• The physician's high and only calling is to
  restore health to the sick, which is called
  healing.
• Ref Organon

3

• Aphorism 2
• The highest aim of healing is the speedy,
  gentle, permanent cure of the sick according
  to clearly intelligible reasons.
• Ref Organon

4

• PREAMBLE
• The physician should understand
• 1st. What is curable in disease in general and
  in each individual case (disease) in particular
  
• 2nd. What is curative in drugs in general and in
  each individual drug in particular
• 3rd. (Medicinal Intervention) How to apply, with
  distinct reason, what is curative in drugs to
  what is curable in diseases, i.e.
• A. How to match the proper remedy to the
  sickness,
• B. How properly to administer the proper dose.
• C. How properly to repeat the dose
• 4th. And how to recognize and remove obstacles in
  the way of recovery.
• Aphorism 3, Ref Organon

5

• THE HEALTH
• The WHO has defined the health as
• Health is a state of complete physical, mental
  and social wellbeing and not merely an absence of
  disease or infirmity, with ability to lead a
  socially and economically productive life.
• Health as defined by Hahnemann
• In health there is harmony in vital processes,
  feeling and function is normal, there is a
  feeling of well being, the mind looks out, the
  senses are alert, the sense perceptions are
  clear and normal.

6

• THE DISEASE
• WHO has defined the health but not disease.

7

• THE DISEASE
• Most acceptable definition of disease is Dis
  Ease Not at ease.
• Disease is expressed by signs and symptoms.
• Symptoms or signs as units of disease
  expression.
• These sign and symptoms are like building blocks,
  when faithfully collected, and judiciously
  arranged (Totality of symptoms) in a correct
  sequence will construct a disease picture.

8

• THE DISEASE
• There are many attempts to define disease.
  Webster defines disease as
• A condition in which body health is impaired, a
  departure from a state of health, an alteration
  of the human body interrupting the performance of
  vital functions.

9

• THE DISEASE
• However the disease is defined By Hahnemann is
  as
• In disease, there are disturbed vital processes,
  feeling and function is abnormal, there is a
  feeling of ill being, the mind looks in, the
  attention is attracted by the perverted
  sensations of abnormal organ function that pass
  unperceived when normal. Thus in disease the
  fundamental sense of existence becomes distorted
  and mental concepts perverted. This phenomenon
  shows in the profoundest manner the indissoluble
  connection between psychic and physiologic life.
  The body is cognized subjectively not objectively.

10

• CAUSATION OF THE DISEASE
• Hahnemannian concept of disease causation
  (Etiology) is as under
• We all are born with an individual intrinsic
  ability to develop disease called miasm.
• Therefore homoeopathic philosophy of causation of
  disease is that the man himself is the agent of
  his disease.
• The individual in his peculiar way interact with
  the environment (lifestyle etc) so as to develop
  their own peculiar and individual diseases.

11

• CAUSATION OF THE DISEASE
• Hahnemannian concept of disease causation
  (Etiology) is as under
• In homoeopathic language, the human host is
  referred to as soil (Miasmatic vulnerability)
  and the disease agent as seed. The disease
  agent could be a biologic, living, non living,
  chemical, physical factor. Its presence or
  relative lack can cause a particular disease.
• Host factor takes account of age, sex,
  ethnicity, genetic factors (Miasmatic traits/
  Non-modifiable factors), and socio-economic
  status, education, occupation, stress, marital
  status, housing, etc, and lifestyle factors such
  as personality traits, living habits, nutritional
  status, physical exercise, use of alcohol, drugs
  and smoking behavioral patterns, (Modifiable
  factors) etc.

12

• THE DISEASE IN GENERAL
• Broadly the disease are grouped in
• Acute diseases
• Chronic diseases

13

• THE DISEASE IN GENERAL
• Acute diseases
• These are caused by transient explosion of latent
  psora. These are self limiting in nature and are
  characterized by
• Sudden onset
• Rapid course
• Culminates in recovery or death

14

• THE DISEASE IN GENERAL
• Acute diseases
• The core presentation
• The constitutional symptoms of the patient are
  thrown into background, and acute
  symptomatology takes forefront.
• (Note this acute totality makes it disease in
  particular, from the homoeopathic point of view)

15

• THE DISEASE IN GENERAL
• Chronic diseases
• These are caused by chronic miasms and are
  characterized by
• Insidious onset
• Slow course
• Lifelong suffering and invariably ends with the
  life of patient.

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• THE DISEASE IN GENERAL
• According to Dr. Hahnemann following are the
  Chronic miasms
• - Primary (Essential/Idiopathic/ Unknown)
• Psora.
• - Secondary ( Acquired)
• Sycosis
• Syphilis
• - Mixed miasmatic state
• Psoro-syphilis ( Tubercular)
• Psoro-Sycosis
• Psoro-Sycosis-Syphilis

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• THE DISEASE IN GENERAL
• Chronic disease
• The core presentation of chronic disease is
  represented with
• The constitutional symptoms are retained along
  with the superimposed diseased picture.
• The constitutional symptoms are at forefront in
  the initial phase of presentation.
• However, as the pathological changes do take
  place the finer symptoms start disappearing.
• (Note the individual nature of the subject is
  closely intermingled other features of chronic
  disease, and that colors it to form a disease in
  particular)

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• PSORIC MIASMATIC FEATURES IN GENERAL
• The core features
• Somatotype Ectomorphic
• Psychic preponderance Eccentric, Philosopher,
  imaginative.
• Tissue affinity ectodermic in origin i.e, Skin
  and Mind (CNS/PNS).
• Disease pace sudden dramatic.
• Predominant disorders Functional disorders,
  alternating diseases and deficiency disorders.
• Mentally full of ideas, hyperactive and
  hypersensitive. Anxious averse to work.
• Desires Sweet, sour, fatty, fried, indigestible,
  spicy, oily, hot food.
• Aversion Milk, boiled food, cold foods.
• Worse In winters, wants warmth externally and
  internally.
• Amel in summer by heat, by natural discharges
  viz. urine, sweat, menstruation etc. by hot
  application, scratching, crying, eating.
  Appearance of suppressed skin eruptions. Time
  early morning and day time.

19

• SYCOTIC MIASATIC FEATURES IN GENERAL
• The core features
• Somatotype Mesomorphic.
• Psychic preponderance Mischief oriented
  COMPETITIVE Beast. Uncontrolled wildness.
• Tissue affinity Ectodermic in origin i.e., Bone
  and muscles.
• Disease pace Insidious / Masked.
• Predominant features Hyperplasia /atrophy, hypo
  / Hyper function.
• Mentally Deceitfulness, Cruel. Quarrelsome.
• Desires Table salt, alcohol, coconut, fat meat,
  well seasoned foods. Peppers, pungent, salty
  foods.
• Aversion Meat, milk, wine, spices. Meat and wine
  aggravate the Sycotic conditions. Intolerance to
  spices. Patient craves beer which causes less
  aggravation.
• Agg From rest, damp, rainy, humid atmosphere,
  during thunderstorm, change of weather from meat.
  Time twilight phase.
• Amel unnatural elimination, through mucus
  surfaces, e.g. leucorrhoea, nasal discharge etc.
  by slow motion, or by stretching, in dry weather,
  lying on stomach or with pressure, return of
  suppressed normal discharges e.g. menses. When
  warts or fibrous growth appears.

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• SYPHILITIC MIASATIC FEATURES IN GENERAL
• The core features
• All Somatotype characterize with destruction and
  deformities.
• Psychic preponderance Dull, self destructive
  traits.
• Tissue affinity all tissues, especially MM,
  Bones, visceras, and CNS.
• Disease pace Insidious.
• Predominant feature destruction / ulceration.
• Mentally Dull.
• Desires Stimulants, alcohol, tea coffee,
  smoking, very spicy meat, cold food, sour things.
  
• Aversion Meat especially less spicy. Aversion to
  animal food.
• Agg Sunset to sunrise, perspiration. Seaside,
  sea voyage, from thunderstorm. Warmth, summer
  night, sweat, extremes of temperature, from
  movements, perspiration, warmth of bed.
• Amel From sunrise to sunset. Change of position.
  Luke warm climate, from any abnormal discharges.
  Amelioration during winter, from cold in winter.
  Through discharge of pus if old ulcer opens
  up.

21

• PSEUDO-PSORA (TUBERCULAR) MIXED- MIASATIC
  FEATURES IN GENERAL
• The core features
• Somatotype Exaggerated Ectomorphic state.
• Psychic preponderance Dissatisfied, changeable,
  vagabond cosmopolitan.
• Tissue affinity all tissues, and especially
  lymph nodes.
• Disease pace Variable.
• Predominant feature Drainage and wasting.
• Mentally Vagabond, cosmopolitan changeable,
  dissatisfied. Absolute lack of fear. hopeful.
• Desire Likes clay etc. potato, salt, fatty
  greasy and salty foods. Craves things which make
  him sick. Desires tea, tobacco, meat, craving for
  salt. Extremes likes hot or really cold things.
  Thrives better on fats and fatty foods. Starches
  are not easily digested.
• Aversion Aversion to meat.
• Agg From thunderstorm, night, milk, fruits,
  greasy and oily foods. Closed room. pressure in
  the chest.
• Amel In dry weather, open air, daytime.
  Temporarily offensive foot or axillary sweat
  which when suppressed induces lung trouble. By
  nose bleeding.

22

• NATURAL HISTORY OF DISEASE IN GENERAL
• The true record of a disease from onset to
  termination in nature without any medical
  intervention is known as Natural History of
  Disease.
• The natural history of any given disease is
  constructed after observing the same in many
  individuals having different age, sex,
  occupation, religion, geographic diversity, and
  race, at times in an epidemic in case of acute
  disease and over the generation in many chronic
  diseases.
• It includes its, etiology, onset, course
  (different shades of the disease), asymptomatic,
  mild, moderate, severe. Its duration,
  culmination in recovery, sequale, or death.
• The current (investigative) medical knowledge
  helps us to quantify the disease accurately, for
  diagnostic, prognostic, research needs. This
  information, provides us with guideline to make a
  intervention plan with a idea of possible
  outcome, at every given stage and phase of the
  disease.

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• NATURAL HISTORY OF ACUTE DISEASE IN GENERAL
• Natural history of acute disease has four stages
• 1st stage Incubation stage latent period.
• 2nd stage Prodromal stage.
• 3rd stage Progressive stage.
• 4th stage Recovery or death.

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NATURAL HISTORY OF ACUTE DISEASE IN GENERAL
Host
Agent
Environment
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NATURAL HISTORY OF ACUTE DISEASE IN GENERAL
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NATURAL HISTORY OF ACUTE DISEASE WITH
INTERVENTION PLANNING IN PARTICULAR
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• NATURAL HISTORY OF CHRONIC DISEASE IN GENERAL
• Natural history of chronic disease has following
  five phases, i.e.
• 1st stage Latent phase.
• Latent miasm/ can be ascertained by close
  interrogation and observation of the subject
  concern.
• 2nd stage Flare of chronic miasm.
• Primary Miasmatic presentation Disease Specific
  predisposition .
• 3rd Stage Chronic Compromised phase
• Early Secondary presentation Compensatory phase
  (Disease specific).
• 4th Stage Decompensated function
• Late Secondary presentation Deconpensatory phase
  / Full blown S/S (Disease specific).
• 5th Stage End stage
• The Tertiary (Terminal) Presentation
  COMPLICATIONS / sequlae.

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NATURAL HISTORY OF CHRONCIC DISEASE CAD - IN
GENERAL
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NATURAL HISTORY OF CHRONCIC DISEASE -CAD AND ITS
INTERVENTION PLANNING With POTENCY SUGGESTION IN
PARTICULAR
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INTERVENTION PLANNINGBASED ON NATURAL HISTORY
OF DISEASE

• THIS MODEL PROVIDES US DISTINCTLY TWO STAGES AND
  FIVE PHASES IN PARTICULAR FOR INTERVENTION.
• BASED ON ABOVE GUIDELINES A COMPREHENSIVE
  TREATMENT PLAN PROVIDES US EVIDENCE BASED
  OPPORTUNITY TO EXPLOIT THE HOMOEOPAHTIC DRUG
  APPLICATION IN PREVENTIVE, PROMOTIVE, AND
  CURATIVE ASPECT OF MEDICAL MANAGEMENT

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• DISEASE IN PARTICULAR
• The disease in general becomes -
• disease in particular with following data
• Patient identification information Name / Age /
  Sex / Occupation / Religion / Marital status /
  Nationality.
• Individual characteristic of patient M/G, P/G,
  P/G with Modalities.
• Totality S/S Ref to patient as individual
  (disease in particular) and Drug-in particular-
  to be matched to have the similimum.
• Stage and Phase of disease (information about
  what is curative in individual disease)

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PRIMORDIAL PREVENTION IN PARTICULAR

• This encompasses. health education and health
  promotion, which starts from the home only and
  includes healthy lifestyle practice adapted by
  parents and passed on to children as part of
  habit. Habit is second nature of man.
• Allopathic concept has no choice of medial
  intervention at this stage. For a homoeopath
  Primordial prevention starts with the birth. The
  years of infancy and childhood are marked by
  great cellular and structural activity of growth.
  As such they are distinctly favourable to
  influence of MIASMATIC REMEDIES. These remedies
  are based on the maternal / paternal miasmatic
  analysis.
• So great is difference in susceptibility between
  child and adult life. Therefore, the inherited
  diathesis can be modified to a great extent by
  giving miasmatic treatment.
• In the adults whose foundations lie deeply rooted
  in the miasms are very intractable and often
  irremovable.

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PRIMARY PREVENTION IN PARTICULAR

• It refers to processes involved in reducing the
  risk that people will fall ill by specific
  diseases.
• For acute infectious diseases e.g. homoeopathic
  prophylaxis is used.
• In case of chronic diseases identification of
  high risk factors and effective control /
  elimination of same. Along with Specific
  constitutional medication is of great value.
• This is the stage when constitutional features
  S/S are in abundance and chances of choice of
  homoeopathic constitutional medicine is
  excellent. The majority of Symptoms are
  encountered which are subjective and belong to
  sensation as if in nature.

34
EARLY SECONDARY PREVENTION IN PARTICULAR

• At this phase the individual nature of the
  patient (individuality) is still preserved,
  particular nature of symptom syndrome (Totality)
  is CLEARLY recognizable.
• As the disease is in the early reversible stage,
  THEREFORE this is the stage when CLASSICAL cure
  can be achieved.
• Early diagnosis, e.g. screening investigations
  are very helpful in early diagnosis and goes in a
  long way to satisfy the evidence based medicine
  treatment plan.

35
EARLY SECONDARY PREVENTION IN PARTICULAR
Note Homeopathy works by stimulating the bodys
own immune system so that illness is resolved
naturally from within. Younger patients tend to
have decisive and clear-cut reactions to
homeopathy, since their levels of vitality are
correspondingly higher than those of the average
adult and old.
36
LATE SECONDARY PREVENTION IN PARTICULAR

• It refers to activities involved in effective
  management of symptomatic patients.
• However, at this stage disease has established
  irreversible pathological state.
• S/S are of vegetative state are on rise and the
  true individualizing feature of the diseased
  man are on decline, and even if they are present
  the irreversible pathology itself acts as
  obstruction to recovery.
• In some rare cases if one gets a dependable
  totality for Rx, one should be more careful to
  prescribe classically indicated remedy as it
  may result in severe aggravation and final
  decline.
• Treat such patient with extreme care.
• Suggestion is to give symptomatic relief and not
  to strive for cure.

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TERMINAL PREVENTION IN PARTICULAR

• This stage heralds with very advanced pathology
  which is irreversible and in terminal
  decompensatory state.
• The individual nature of the disease is lost.
  s/s are gross and due to organ failure general
  features of disease prevail.
• This stage demands palliative / symptomatic
  management.
• This stage also needs rehabilitation services,
  which aim at returning sick people as soon as
  possible to maximum effectiveness. Even where an
  individual may be suffering from a condition,
  which cannot be cured, it is often possible to
• Reduce the impact of disease, e.g. physiotherapy
  to minimise deformities and disability in
  rheumatoid arthritis.
• Eliminate adverse effects, e.g. counselling to
  prevent depression in physically or mentally
  disabled person.

38

• DISEASE IN GENERAL AND
• CONCEPT OF CURE
• The disease in general is taken into
  consideration from allopathic point of view.
• Most of the acute diseases recognized on the
  basis of nosological diagnosis based on COMMON
  SYMPTOMS AND identifying CAUSATIVE organism.
• So called Cure is affected by killing the
  microorganism by the use of antibiotics.

39

• DISEASE IN GENERAL AND
• CONCEPT OF CURE
• Example
• Tonsillitis, typhoid, UTI all are treated with
  antibiotics.
• Cure is established by taking throat swab, stool
  examination, for C/S, Urine examination for C/S
  and showing no bacterial growth.

40

• DISEASE IN GENERAL AND
• CONCEPT OF CURE
• Now-a-days, current concept of modern medicine
  are taken as golden standards in reference to
  disease diagnosis and outcome of treatment.
• The modern medical man would like to judge the
  outcome of homoeopathic / ayurvedic treatment
  as per his concept of the disease causation and
  its treatment what they think correct.

41

• DISEASE IN PARTICULAR AND
• CONCEPT OF CURE
• Homoeopathic concept of health is harmony with
  self, and environment. As a matter of fact the
  mother earth was inherited by microorganisms
  before we came on the scene.
• As we come in confrontation with these organisms
  and when our susceptibility is undermined we get
  infection.
• Homoeopathic medicines helps us to regain the
  optimum healthy state by treating the individual
  with the concept of disease in particular.

42

• DISEASE IN PARTICULAR AND
• CONCEPT OF CURE
• Once the individual recovers he is free from
  signs and symptoms, and homeopathically there
  remains nothing but healthy state.
• However, if one takes the throat scab or goes for
  stool examination for C/S, some of the cases may
  come positive for the organism.
• This typical phenomenon shows that the person is
  not suffering / or is not susceptible to disease,
  yet organisms may remain there, in perfect
  harmony with the individual.

43

• DISEASE IN PARTICULAR AND
• CONCEPT OF CURE
• We all know that in cases of Herpes Zoster the
  organism was dormant and was present since years
  together in the posterior root ganglion, but did
  not cause the disease.
• The person becomes sick only when the psora
  gets flared up due to exciting, causes.
• The stress / strain and other factors causes
  breach in the susceptibility of the subject
  temporarily which is enough to excite the
  friendly dormant micro-oganism.

44

• CHRONCI DISEASE IN PARTICULAR AND
• CONCEPT OF CURE
• The chronic diseases are caused by chronic
  miasms.
• Miasms cannot be eliminated as they are the part
  of organism.
• Miasms get activated in presence of favorable
  circumstances which are exciting and maintaining
  (environmental) causes leading to activation
  ch. disease.
• Remedy selected on Similimum puts the disease
  activity in remission. The terms cure is used
  in case of acute disease and remission /
  latency in chronic disease.

45
Thank You
46
THE DISEASE IN PARTICULAR Natural history of
Acute COLD and its Intervention Planning in
Particular (Pt. may present to physician in any
stage or Phase of disease)
47
NATURAL HISTORY OF ACUTE DISEASE with
INTERVENTION PLANNING
48
(No Transcript)
49
THE DISEASE IN PARTICULAR Natural history of
Chronic Disease and its Intervention Planning
in Particular (Pt. may present to physician in
any stage or Phase of disease)
50
NATURAL HISTORY OF CHRONCIC DISEASE -CAD ITS
STAGES / PHASES AND INTERVENTION STRATEGY With
POTENCY SUGGESTION
51
HYPERTENSION
PATHOLOGYCAL ASPECTS
52
VASCULAR CHANGES
53
ARTERIOLES

• Normally observed in ageing, accentuated by
  hypertension.
• Haemodynamic stress of hypertension results in
  endothelial injury causing
• -Leakage and hyaline deposition in intima and
  media.
• -Arteriolar wall thickening.
• -Narrowing of lumen

Hyalinisation
54
SMALL AND MEDIUM SIZED ARTERIES

• Medial muscular hyper-trophy and later fibrosis.
• Duplication of elastic lamina.
• Intimal proliferation.
• Narrowing of lumen.
• Formation of atheroma in the regions of
  haemo-dynamic turbulence.

55
LARGE ARTERIES (Atherosclerosis)
Foam cells Extracellular lipid
pool Smooth muscle cells Thrombus
2
1
1. Fatty streak 2. Transitional plaque 3.
Mature plaque 4. Ruptured plaque with
thrombus formation
3
4
56
ANEURYSM FORMATION

• Degeneration of medial layer of the artery due to
  atherosclerosis.
• Loss of elastic tissue of the vessel.
• Decreased resistance to the distending force.
• Uniform dilatation of artery or local bulging at
  the point of potential weakness.

57
PRIMORDIAL PREVENTION

• Aim of primordial prevention is General
  Prevention for masses. It includes mass
  awareness programmers, On media i.e., T.V., News
  Papers, Public lectures, Health camps in melas,
  poster competition in schools, to make the public
  aware about lifestyle and risks for developing
  Healthy living, healthy food habits.

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PRIMARY PREVENTION GUIDELINES

• Specific protection in reference to HT and CAD.
  Identify the un-modifiable and modifiable risk
  factor at the individual level and strive to
  correct the modifiable factors. Aim of general
  management is to control and maintain blood
  pressure within the acceptable limits and to
  prevent complications.
• Stop smoking.
• Low calorie, low fat, high fibre diet.
• Reduce salt intake.
• Correct obesity.
• Moderate regular exercise within the limits of
  cardiovascular status.
• Stress management rest, relaxation and
  recreation.
• Changing ones attitude towards work and life
  situation in general.

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PRIMARY PREVENTION GUIDELINES
RISK FACTOR SCREENING

• Begins at age 20 years including
• Smoking status, diet, alcohol, and physical
  activity.
• Blood Pressure, Body Mass Index (BMI), waist
  circumference at each visit or at least every 2
  years.
• Fasting Cholesterol panel and glucose every 5
  years every 2 years if risk factors are present

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SECONDARY TERTIARY PREVENTIVE AREAS OVERLAP
AND THEY ARE AS -
61
RETINAL CHANGES
62
FUNDUSCOPIC FEATURES

• Funduscopy is a reliable index of the severity,
  duration and prognosis of hypertension.
• There is a direct relation between the fuduscopic
  grading and prevalence of the complications of
  hypertension.

Normal Fundus
Grade I changes (mild H.T.) Grade II changes
(moderate or sustained H.T.) Grade III and IV
changes (severe or malignant H.T.)
63
FUNDUSCOPIC FEATURESKeith - Wagner - Barker
classification
Grade I Changes
Grade II Changes
Narrowing and irregularity of retinal arteries
Marked narrowing with arterio-venous nipping
64
FUNDUSCOPIC FEATURES Keith - Wagner - Barker
classification
Grade III Changes
Grade IV Changes
Cotton wool exudates Flame shaped haemorrhages
Grade III Changes Papilloedema
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CARDIAC COMPLICATIONS
66
LEFT VENTRICULAR HYPERTROPHY

• It is a direct response to increased strain
  imposed on heart and vessels.
• Left ventricle has to pump blood with increased
  force of contraction.
• This leads to increased stretching of myocardial
  fibres causing ventricular hypertrophy.
• As the heart wall thickens the oxygen demand is
  increased.

Arnica, Crataegus., Rhus.tox., Spartium.
67
LEFT VENTRICULAR FAILURE

• Myocardial hypertrophy becomes detrimental due to
  increased metabolic requirements of enlarged
  muscle mass.
• In the course of time dilatation of the ventricle
  occurs.
• It transgresses the point at which the myocardial
  tension cannot be generated.

Adonis, Apoc., Conval., Crat., Dig., Iberis,
Naja, Spart., Stroph., Vis. alb.
68
CORONARY ARTERY DISEASE

• Atheroma formation in coronary arteries, with
  relative insufficiency of blood and oxygen to
  myocardium.
• Clinically characterised by stable and unstable
  angina pectoris.
• Patient may present with myocardial infarction.

69
CORONARY ARTERY DISEASE
1
2
3
Myocardial Infarction
Stable Angina Pectoris
Unstable Angina Pectoris

• Aconite, Amyle nit., Arnica, Aur. met., Boerr.
  diff., Cactus, Crataegus, Haematox., Latrodectus,
  Spartium, Spigelia, Strontia, Tabacum,
  Terminalia, Vanadium.

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CEREBROVASCULAR COMPLICATIONS
71
CHARCOT-BOUCHARDS ANEURYSM

• Micro-aneurysms of less than 1 mm diameter form
  in the small perforating arteries of the brain,
  especially in basal ganglia and subcortical
  areas.
• These are particularly prone to rupture and cause
  multiple small haemorrhages.

Micro- aneurysm
Bleeding from artery
Perforating artery
Baryta. carb., Baryta. mur., Phosphorus.
72
MULTI-INFARCT DEMENTIA

• Small infarcts or lacunae ranging from 2-15 mm in
  diameter are common in brain in many patients,
  with hypertension.
• Lacunae form due to occlusion of deep arterioles
  as a result of arteriosclerosis.
• Patients present with progressive dementia, with
  no other focal neurological feature.

Bar. carb., Bar-Mur, Phos..
73
BINSWANGERS DISEASE

• Patchy, irregular loss of cerebral white matter,
  with widespread gliosis (subcortical
  leuco-encephalopathy).
• Severe arteriosclerosis results in reduced
  perfusion of white matter during periods of
  relative hypotension resulting in multiple
  infarcts.

• Characterised by memory impairment and dementia,
  with reduction of the cognitive skills.

Baryta carbonica Phosphorus Plumbum iodatum
74
BINSWANGERS DISEASE

• CT Scan showing multiple cerebral infracts and
  dilated sylvian fissure

Baryta carbonica Phosphorus Plumbum iodatum
75
TRANSIENT ISCHAEMIC ATTACK

• Due to early vascular insufficiency as a result
  of atherosclerosis.
• Characterised by focal neurological deficit.
• Deficit recovers within 24 hours completely.
• It is a warning sign of impending complete
  vascular obstruction.

Acon., Bar. c., Bar. m., Conium, Lachesis
76
CEREBRAL THROMBOSIS

• Cerebral blood flow is completely arrested.
• The resulting ischaemia causes infarction of the
  affected cerebral territory.
• Stuttering progression.
• Focal neurological deficit, with or without
  unconsciousness.
• Persists beyond 24 hours.

Aconite, Arnica, Bothrops, Lachesis
77
CEREBRAL HAEMORRHAGE

• Haemorrhage from
• -Rupture of aneurysm or atherosclerotic artery.
• Small haematoma (lt I inch diameter) resolves
  slowly in 8-24 weeks and replaced by cystic
  cavity or cleft.
• Large haematoma is usually always fatal.

A
B
CT SCAN Head A. Acute Intra-cerebral Haemorrhage.
B. Resolved lesion leaving a slit shaped defect
Aconite, Arnica, Lachesis., Phosph.
78
CEREBRAL HAEMORRHAGE
79
HYPERTENSIVE ENCEPHALOPATHY

• Severe headache.
• Nausea, vomiting.
• Convulsions.
• Drowsiness.
• Transient paresis.
• Speech and vision disturbances.
• Disorientation.
• Unconsciousness.
• Papilloedema.

• Acute, transient disturbances of cerebral
  function due to rapid rise of diastolic blood
  pressure (gt140 mm Hg).
• Failure of the auto-regulatory control of the
  blood pressure.
• Crisis lasts from few hours to several days.
• Usually ends in recovery.

Apis mellifica, Belladona
80
VASCULAR COMPLICATIONS
81
ANEURYSM OF AORTA

• Natural history of an aneurysm is expansion and
  it may eventually rupture.
• Abdominal aorta between renal and iliac arteries
  is the commonest site.
• The thoracic aorta may also be affected.

Abdominal Aneurysm
Thoracic Aneurysm
Ars. iod., Bar. carb., Bar. mur., Cactus,
Crataegus., Lycopod.
82
ANEURYSM OF ABDOMINAL AORTA
83
DISSECTING ANEURYSM

• It results from a tear in intima of aorta
  followed by entry of blood into the plane of
  media and separation of a flap of intima from the
  rest of aortic wall.
• Type A aneurysm arises in ascending aorta.
• Type B aneurysm is confined to descending aorta.

Arnica, Carbo veg., Lachesis, Phosphorus
84
PERIPHERAL ATHEROSCLEROSIS

• Characterised by
• Intermittent claudication.
• Poor peripheral arterial pulsation.
• Ischaemic peripheral neuritis.
• Ulceration of toes.
• Dry gangrene.

Classical skin changes
Ulcer
Ars. alb., Bar. c., Bar. m., Crat., Carb. veg.,
Phos., Sec. cor.
85
RENAL COMPLICATIONS
86
RENAL FAILURE

• Kidneys display a high degree of autoregulation
  of blood flow and GFR.
• Renal failure is a late and terminal
  complication, usually secondary to
• -Progressive loss of nephrons as a result of
  nephrosclerosis.
• -Progressive atheroma of renal artery.
• -Cardiac failure.

Kidney small and, contracted
Surface granular
Adon., Apoc., Cup. ars., Eel serum, Urea.
87
MALIGNANT HYPERTENSION
88
Malignant hypertension may develop as a primary
presentation in young subjects or as a
complication of essential hypertension. It is a
medical emergency.

• Very high and sustained systolic and diastolic
  pressures, with diastolic pressure
  disproportionately high above 120 mm Hg.
• Acute headache.
• Acute visual disturbances.
• Haematuria.
• Proteinuria.
• Papilloedema.

• Rapid development of cardiac and renal failure.
• High blood urea and serum creatinine.
• Lack of response to routine therapy.
• Rapid downhill course.
• Poor prognosis.

89
PROGNOSIS

• Prognosis largely depends on the efficiency of
  treatment, and extent of target organ damage,
  which is proportional to the degree of blood
  pressure, and this gradient of the risk extends
  down into the range of blood pressure that can be
  conventionally described as normal.

• Risk Strata
• (10 year risk of
• C.V.A. or M.I.)
• Low risk lt 15 risk.
• Medium risk 15 - 20 risk.
• High risk 20 - 30 risk.
• Very high risk 30 or more risk.

90
STRATIFICATION OF RISK TO QUANTIFY PROGNOSIS
Grade I (Mild H.T.) SBP 140-159 DBP 90-99
Risk factors Disease history
Grade III (Severe H.T.) SBP ? 180 DBP ? 110
Grade II (Moderate H.T.) SBP 160-179 DBP 100-109
1. No other risk factor
Low risk
Medium risk
High risk
2. One or two risk factors
Very high risk
Medium risk
Medium risk
3. Three or more risk factors or D.M., or
target organ damage
High risk
Very high risk
High risk
Very high risk
Very high risk
Very high risk
4. Complications
91
Time has come that everybody should realize the
scope and role of homoeopathic science for day to
day problems. When in doubt, when other systems
of medicine fail to work quickly, and if an
individual needs to grow with natural, safe,
non-toxic, effective and quick acting medicine,
one should think of homoeopathy. The mother and
child make the most eligible candidates for
homoeopathy, with its gentle, rapid recovery and
innocuous sweet pills.
92
THANK YOU