Hypertension of Different Kind
NATIONAL JOURNAL OF HOMOEOPATHY 1996 Jan / Feb Vol V No 1.
Mansoor Mirza.

A sphygmomanometer cannot measure the normal, increased or decreased pressure to clinically label and individual suffering from this disease. This is because it is not peripheral arterial blood pressure which is responsible for this"hypertension" but a rise in pulmonary arterial pressure giving rise to an entity known as Pulmonary Hypertension.

The patients presenting with this disorder may complain of gradual shortness of breath with effort which may progress to dyspnoea with minimal activity. They may also, in addition, complain of fatigue, angina -pectoris, syncope, near syncope and peripheral oedema.

Causes for Pulmonary hypertension are:

1. Primary:
   Where the underlying cause is unknown (probably immunologically mediated. Suggested by high frequency of antinuclear antibodies).
2. Secondary:
   1. Persistent fetal circulation
   2. Congenital heart disease
   3. Valvular heart disease
   4. Primary myocardial disease
   5. Pulmonary thrombo-embolism
   6. Obstructive lung disease
   7. Interstitial lung disease
   8. Arterial hypoxaemia with hypercapnea
   9. Collagen vascular disease
   10. Parasitic disease involving the lung
   11. Sickle cell anemia
   12. Intravenous drug abuse
   13. Granulomatous lung disease
   14. Chronic liver disease
   15. Pulmonary artery stenosis
   16. Pulmonary venous hypertension
   17. Aminorex fumarate ingestion.

The physical examination shows valuable signs such as increased jugular venous pressure, a reduced carotid pulse and an easily palpable right ventricular lift increased component (pulmonic) of second heart sound and right sided third and fourth heart sounds. Tricuspid and pulmonary regurgitation and peripheral cyanosis and oedema may be noted.

Investigations reveal the following: (in Primary Pulmonary Hypertension).

1. X-ray chest-Enlarged central pulmonary arteries and clear lung fields.
2. ECG-Right axis deviation and right ventricular hypertrophy.
3. Echo cardiography-Right ventricular enlargement, a reduction, in left ventricular size and abnormal septal configuration consistent with right ventricular pressure load.
4. Doppler studies-reveal; marked dependence upon arterial systole for ventricular filling.
5. Pulmonary function tests-Mild restrictive pattern.
6. Blood Gas studies: Hypoxaemia, hypocapnea, abnormal diffusing capacity for co.
7. Perfusion lung Scan-(N) or abnormal with multiple diffuse patchy filling defects of non-segmental nature. If defects are segmental in nature then a pulmonary angiogram must be done to rule out chronic pulmonary thrombo embolism.
8. Cardiac catheterization-is mandatory to characterize the disease and exclude an underlying cardiac shunt as an etiology.

In cases of secondary pulmonary hypertension the investigation may reveal a picture similar to that of the underlying disorder.

Pulmonary artery wedge pressure is measured by the Swan-Ganz catheter. Normal individuals in supine position have a pressure of 15-25 mmtly/5-10 mmtly (at sea-level). It is said to be raised when it increases by 5-10 mm Hg ie from 25/10 Hg to 35/15 mm Hg.

The initial disease is largely asymptomatic. Mean survival rate from diagnosis is 2-3 years. However occasionally patients survive more than 10 years. The cause of death is usually right ventricular failure or sudden death.

Management of patients with primary pulmonary. Hypertension is unsatisfactory in modern medicine. Usually vasodilator drugs are the mainstay of therapy occasionally combined with diuretics and anticoagulants therapy. Patients not responding to vasodilator drugs, in advanced stages of disease are considered as candidates for heart lung transplantation.

This is one area of medicine for which modern medical therapeutic measures have not been able to achieve a breakthrough in terms of long term palliation or cure. Hence it is a challenge to homoeopathic physicians to try to start treating patients of pulmonary hypertension with constitutional remedies in order to improve their quality of life and if possible cure them of "this different kind of hypertension".

References:

1. Pulmonary diseases and disorders-Alfred Fishman, II edition.
2. Principles of Internal Medicine_Harrison, 12th edition.
3. Principles and Practice of Medicine-Davidson, 16th edition.

Humming Away Hypertension.
Homoeopathically
The following description.
Of the disease Im going to mention
Is the rise in arterial blood pressure
Known as Hypertension.
After ruling out the secondary cause.
Be it drugs, renal or endocrine.
It is Essential Hypertension primarily,.
Thats what the physicians opine.
Symptoms are headache, dizziness and syncope
Cerebral stroke or kidney failure
Even death due to myocardial infarction.
Restrictions in salt and saturated fat. Overcoming stress and inevitable strain:.
Prevents damage to the eyes,.
Heart, kidneys and brain.
Besides yoga and meditation.
For this chronic and serious malady.
The patient is most benefited and cured
By a Similar Homoeopathic remedy.

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