· Coronary heart disease is a type of heart disease where the arteries of the heart cannot deliver enough oxygen-rich blood to the heart. This is due to the buildup of cholesterol and other material, on their inner walls called atherosclerosis. As a result, the heart muscle can’t get the blood or oxygen it needs. This can lead to chest pain (angina) or a heart attack1. Coronary artery disease is the foremost single cause of mortality and loss of Disability Adjusted Life Years (DALYs) globally. In 2015 CAD accounted for 8.9 million deaths and 164.0 million DALYs2. In India in 2016, CVDs contributed to 28.1% of total deaths and14.1% of total disability-adjusted life years3. Hrudroga is explained in various Ayurvedic texts. It occurs due to Pranavaha – Rasavaha srotodushti. The causative factor can be understood as agnimandya (poor metabolism) leading to ama which causes rasa dushti and that may lead to upalepatva (coating), sanga (obstruction) in rasavaha srotas (vessels) which hampers vyana vayu leading to Hrudroga4 Modern interventions for CAD include stenting and bypass surgery which are time taking, invasive and expensive. Ayurvedic line of management for Hrudroga include vamana5, virechana6 and basti7 etc. The treatments such as virechana and basti are the major shodhana procedures which cleanse the body by removing the ama (toxins) thereby clearing the margavarodha (obstruction) which helps in the treatment of disease condition. So, in the present study Virechana followed by Bilwadi Kashaya Basti7 is undertaken. For Deepana-Pachana, Trikatu churna8 is advised and for Snehapana Bilwadi taila is used followed by Abhyanga with Murchitatila taila and Bashpa sweda. Danti haritaki9 is taken for Virechana. It is sukha virechaka and niratyaya mentioned by Acharya Charaka. As Hrudaya is one of the sadyapranahara marma10. Acharya Charaka has mentioned basti for marma paripalana11. Bilwadi kashaya basti helps to regulate the movement of vata dosha, strengthens and nourishes the cardiac muscle. To put forward effective strategies for management and treatment of CAD through ayurvedic treatment this study is undertaken. Hence the present study entitled as “AN OPEN LABELLED OBSERVATIONAL CLINICAL TRIAL TO EVALUATE THE COMBINED EFFECT OF VIRECHANOTTARA BILWADI KASHAYA BASTI IN HRUDROGA W.S.R TO CORONARY ARTERY DISEASE "undertaken.
OBJECTIVES OF THE STUDY: · Clinical evaluation of the combined effect of Virechanottara Bilwadi Kashaya Basti in Hrudroga w.s.r to Coronary Artery Disease. Ø ASSESSMENT CRITERIA: • SUBJECTIVE PARAMETERS: 1. Hrutshoola ( Angina ) 2. Swasavarodha(Dyspnea) 3. Hrudrava(Palpitation) 4. Klama ( Fatigue) 5. Sweda (Sweating)
1. Hrutshoola (Angina) Canadian Cardiovascular Society grading of angina pectoris | Grade I | Ordinary physical activity does not cause angina, such as walking and climbing stairs. Angina with strenuous or rapid or prolonged exertion at work or recreation | | Grade II | Slight limitation of ordinary activity. Walking or climbing stairs rapidly, walking uphill, walking or stair climbing after meals, or in cold, or in wind, or under emotional stress, or only during the few hours after awakening. Walking more than two blocks on the level and climbing more than one flight of ordinary stairs at a normal pace and in normal conditions | | Grade III | Marked limitation of ordinary physical activity. Walking one or two blocks on the level and climbing one flight of stairs in normal conditions and at normal pace | | Grade IV | Inability to carry on any physical activity without discomfort, anginal syndrome may be present at rest | According to New York Heart Association 1. Swasavarodha (Dyspnea) | NYHA CLASS OF DYSPNEA | DEFINATION | | Grade I | Ordinary physical activity does not cause undue dyspnea. | | Grade II | Ordinary physical activity causes dyspnea. | | Grade III | Comfortable at rest; less than ordinary physical activity causes dyspnea. | | Grade IV | Symptoms occur at rest; any physical activity increases discomfort. | Hrudrava (Palpitation) | NYHA CLASS OF PALPITATION | DEFINATION | | Grade I | Ordinary physical activity does not cause undue palpitations. | | Grade II | Ordinary physical activity causes palpitations. | | Grade III | Comfortable at rest; less than ordinary physical activity causes palpitations. | | Grade IV | Symptoms occur at rest; any physical activity increases discomfort. |
Klama ( Fatigue) | NYHA CLASS OF FATIGUE | DEFINATION | | Grade I | Ordinary physical activity does not cause undue fatigue. | | Grade II | Ordinary physical activity causes fatigue. | | Grade III | Comfortable at rest; less than ordinary physical activity causes fatigue. | | Grade IV | Symptoms occur at rest; any physical activity increases discomfort. | Sweda (Sweating) | SWEATING CLASS | DESCRIPTION | | Grade I | No sweating present, even during physical activity or stress | | Grade II | Occasional sweating, typically during intense physical activity or under significant stress | | Grade III | Frequent sweating occuring during moderate physical activity or stressful situations. | | Grade IV | Profuse sweating occuring even at rest or with minimal physical activity, often accompanied by other symptoms such as shortness of breath or chest discomfort |
OBJECTIVE PARAMETERS: 1. Lipid profile | Total serum cholesterol | Normal - < 200mg/dl Borderline high – 200-239mg/dl High - >240mg/dl | | Low density lipoprotein | Normal -100-130mg/dl Mild -130-159mg/dl Moderate-160-189mg/dl Severe - > 189mg/dl | | Triglycerides | Normal < 150mg/dl Mild – 150- 499mg/dl Moderate- 500-886mg/dl Severe > 886mg/dl | | High density lipoprotein | Low range -< 40mg/dl High protective range > 60mg/dl | Ejection Fraction The simplest classification as per the American College Of Cardiology (ACC) that is used clinically as follows: | Hyper dynamic | LVEF greater than 70% | | Normal | LVEF 50% to 70% | | Mild dysfunction | LVEF 40% to 49% | | Moderate dysfunction | LVEF 30% to 39% | | Severe dysfunction | LVEF less than 30% | Blood pressure: Recommended by American Heart Association | Blood pressure category | Systolic mm hg | Diastolic mm hg | | Normal | Less than 120 | Less than 80 | | Elevated | 120 - 129 | Less than 80 | | High blood pressure (Hypertension) stage 1 | 130 - 139 | 80 - 89 | | High blood pressure (Hypertension) stage 2 | 140 or higher | 90 or higher | | Hypertension crisis | Higher than 180 | Higher than 120 | Ø OVERALL ASSESSMENT: · Marked relief-above 75% improvement. · Moderate relief-50%-75% improvement. · Good relief -25% -50% improvement. · Mild relief - below 25% improvement. · No relief – 0% Ø OVERALL ASSESSMENT: · Marked relief-above 75% improvement. · Moderate relief-50%-75% improvement. · Good relief -25% -50% improvement. · Mild relief - below 25% improvement. · No relief – 0% |