Management Of Ischeamic Heart Disease

in the Light Of Advia-e-Qalbia

Presented byDr Mohd Shahid

P G ScholarD/O Moalajat

NIUM Bangalore

Summary Introduction Definition Classification AnatomyPathologyFactors responsible for IHD

Primary prevention Etiopathogenesis Clinical features Line of Management Treatment

“Heart is a miracle organ that starts working as soon as 21st day of conception in mother’s womb and goes on till the last breathes of life. It keeps pumping the blood to the cells of human body, spending sleepless nights and days i.e. lifetime. However, even the importance of heart is countless; we often get casual about our heart”.

IntroductionCardiovascular diseases (CVD) are

responsible for nearly 50% (17.3 million of deaths due to noncommunicable diseases (NCDs).

Out of the 17.3 million deaths, heart attacks and strokes account for 7.3 million and 6.2 million respectively.

Projected estimates reveal that in 2030 coronary heart disease and cerebrovascular disease will continue to be the leading causes of the global disease burden.

Cont....An action plan for implementation of a Global

Strategy for prevention and control of NCDs including CVD was endorsed by the World Health Assembly in 2008.

DefinitionIHD is define as acute or chronic form of

Cardiac disability arising from imbalance between the Myocardial supply and demand for oxygenated blood

Ischemia results when there is an imbalance between myocardial oxygen supply and demand

Since narrowing or Obstruction of the Coronory artirial system is the most common cause of Myocardial anoxia, “ CAD” used as synonym

CORONARY ARTERY DISEASEASYMTOMATIC STATE ANGINA PECTORISMYOCARDIAL INFARCTIONCHRONIC ISCHAEMIC HEART

DISEASESUDDEN CARDIAC DEATH

Facts and figures MI occurs every 2 mins in UKAccount for 100,000 deaths annually Cardiovascular death accounts for 40% all

deaths under the age 75 yrs Major cause of cardiac arrest Survival to discharge of all rhythm cardiac

arrests is 10.7%

Mechanisms of ischaemia Ischaemia – disturbance in myocardial

oxygen supply and demand

Impaired coronary artery blood flowAtherosclerosis Coronary artery spasmTachycardia – shortened diastole

Impaired oxygen delivery Hypoxia Anaemia

Increased cardiac work

Anatomy 1. Aorta

2. Right Coronary Artery

3. Left Anterior Descending Artery

4. Circumflex Coronary Artery

5. Left main stem

Atherosclerosis

Risk FactorsFixed

AgeMale sexGenetic factorFamilial and

racial factors

Modifiable

SmokingHypertensionHyperlipidaemiaDiabetes mellitusObesity AlcoholSedentary

lifestyle

Circumflex artery obstruction Lateral infarction ECG changes leads I, AVL and V4-V6 20% cases

Left anterior descending obstruction Anterior infarction ECG changes V1-V4 50% cases – most likely to cause left

ventricular dysfunction

Right coronary artery obstruction Inferior infarction ECG changes in II, III & AVF 30% cases

Posterior myocardial infarction Usually right coronary artery but may be

circumflex ST depression in anterior leads

Clinical FeaturesProlonged cardiac

pain; chest, throat, arms, epigastrium or back

Anxiety and fear of impending death

Nausea and vomiting

BreathlessnessSyncope/Collapse

HISTORYIt was amazing to find that, the knowledge

of heart and its function was much clear to

the man in 4000 B.C itself (Ahmed W et all. Cardiology

with special reference to Al-qanoon and advia wal qalbiya. JISHIM 2007-2008, 6-7.)

There is an abundant literature on

anatomy, physiology and cardiac diseases

described by our Atibba

contd…

Jalinoos (Galen) is the first to explain the

circulation and Ibn Sina has explained the

same in his book ‘Al Qanoon fil tib’.

Jalinoos and Ibn sina - there are 3

ventricles in animal or human heart.

They also stated that there is a pore in the

ventricular septum.

These theories were discarded by Ibn Nafis.

Ibn Nafis He has clearly described the mechanism of

Pulmonary circulation.

He stated that there are only 2 ventricles and

also there is no pore b/w the two vetricles.

Right side is filled with blood.

Left side is filled with blood and Vital spirit. (Husain F et

al. Ibn al-Nafis, A biographical sketch of discoverer of pulmonary and coronary circulaion.. JISHIM 2003,1)

Concept of cardiac disorders

Based on the following fundamentals….

Sue Mizaj

1) Sue mizaj sada(extrinsic factor)

2) Sue mizaj maddi (altered

humour)

3) Sue mizaj Mufrad

4) Sue mizaj Murakkab

Amraaz-e-Trkeeb

Cont.....Amraaz-e-TafarrukAuraam (Inflammatory disease)Amraaz-e-Shirki

“If the altered temperament becomes irreversible then treatment becomes almost impossible”. (Ibne Sina)

Co-Relation of IHD disease in Our System

KhafqaanKhafqaan Qalb ki harkat-e-tabayi mai zyadti ka

naam hai (kitab-ul-teseer )Us harkat ka naam hai, jo Qalb ke andar gair

tabayi tor par ho (Moalajat-e-Buqratiya)Qalb ka Khafqaan ek aisi harkat ka naam hai jo

Qalb mai tezi ke saath musalsal Ikhtilaaj ke mushaaba hoti hai (Kitab-ul-Haavi V-7)

Qalb ki gair tabayi harkat, jo Ikhtilaaj se mushaaba hoti hai. Aur is ka sabab har aisi cheez hai jis se Qalb ko Aziyat pohunchti ho. (Akseer-e- Azam)

AsbaabKhafqaan ka sabab saare badan ka Imtila

hai. Jis ki wajah se Qalb Iztarabi aur Ikhtilaaji harkat karne lagta hai. Taake taklif ya Raghon ki tangi door kar sake

Baaz aukaat Qalb ki Raghon haad Khilt-e-Suadavi jama (Accumulate) ho jane ki wajah se (Kitab-ul-teseer )

Qalb ke andar siyah gaadhe khoon ki wajha se hota hai, jo jigar ke andar behta hai (Kitab-ul-Haavi V-7)

Asbaab cont…..Qalb ko Aziyat pohunchane wale asbab

1. Sue Mizaj Qalb2. Qalb ki ghilaaf ki wajha se3. Qalb ke qaribee Aaza ki Msharikat se a) Maida/Stomach b) Dimaagh/Brain c) Jigar/Liver d) Riya/Lungs e) Tamam hijab

Asbaab cont….. f) Miraaq g) Ama/Intestine h) Reham/Uterus i) tamam badan/ full bodyKhilti MaddaGhair Khilti MaddaWaram(Inflammation)Tafarruk-e-Ittisaal

Asbaab cont…..

Sudda

Asbab-e-gharibaQalb ki badhi hui hissZoef-e-Qalb

Types of Khafqaan 1. Khafqaan Damvi2. Khafqaan Safravi3. Khafqaan Balgami4. Khafqaan Suadavi5. Khafqaan Reehi

6. Khafqaan Suddi

Khafqaan Suddi Qalb ki gair tabayi harkat, jo Ikhtilaaj se mushaaba hoti hai aur is ka

sabab koi sudda hota hai

Advia e Qalbia

The drugs which are used in the treatment of

Amraz e Qalb are …

Mufarreh

Muqawwie Qalb

مفرح .

یہ عربی لفظ ہے جو فرحت سے ماخوذ ہے

پیدا کرنے والی چیز ۔ انبساط :لزت و لغوی تعریف

:ان دواوءں کو کہتے ہیں جو روح کی غیرطبعی حالت کو اصطلاہی تعریفکا سبب بنتی ہیں ۔ انبساط درست کرکے فرحت و

بعض قوتوں میں لذت کا احساس اس وقت ہوتا ہےجب غیر طبعی حالت ان سے زاءل ہوجاتی ہے۔

قلب مقوی معتدل کرے کہ ایسا مزاج کو اسکے ءاور قوام عضو ہے جو دواء وہ دراصل

مواد جو اس عضوء کی طرف انصباب کرنے والے ہوں انکو روکے، یا فضول

آاتے ہوں انکو روکدے، یا اس دواء کا مزاج ایسا معتدل آافات اس عضوء پر جو

ہو کہ اس اعتدال کی وجہ سے عضوء کی تبرید میں تسخین اور تسخین میں

تبرید پیدا ہوجیسے گل مختوم، تریاق اور روغن

گل وغیرہ۔

Drugs mentioned which lower the hyperlipidaemia…..

Garlic(lahsan)

Tinospora cordifolia

(Gilo)

Terminalia arjuna

(Arjun)

Ocimum sativum(Tulsi)

Curcuma longa (Haldi)

Hypolipidemic activity

علاج اصولSabab ka izala karen

Agar sirf sue mizaj hai to

taadeel se hi kaam lenSue mizaj maddi hai to tanqiya kare

نسخہ Nuskha baraye Khafqaan SuddiTukhm kasooss, tukhme badranjboya,

shahtra, badiyan har ek 7 mashaBadranjboya, gule surkh, aftimoon har ek

9 mashaBisfaij, daronaj akrabi, har ek 4 mashaTukhm qurtum 1 tola Mawiz munaqqa 3 tolaGule gaouzaban 5 masha, sab ko josh de

kar gul qand 4 tola shamil kar ke 2 hafte tak istemaal karaen.

Cont...Ishaal ke liye;Gule surkh 1.5 tolaBarge sana 2 tolaRevand khatai 9

mashaSheer khasht 4 tola Turanjabeen 3 mashaKhiyar shambar 7

tolaGulab ek botal

Sharbat-e- Ilahi Alvi khan 3 tola

Sharbat warde mukarrar halelji 3 tola

Roghan badam 7 masha, nuskhe mai zyada kar k pilaye

Cont...Kamil tanqie k baad taadil ke liye Khamira Gauzaban, arqe guzar ke sath pilaye

THANK YOU..!!!!