Rheumatic Carditis Or.....?? A Case Study
NATIONAL JOURNAL OF HOMOEOPATHY 1997 Sep / Oct VOL 5 NO 5.
Dr [MS] Meena T Mankani
'Merc-sul
Understanding Rheumatic Carditis:
Rheumatic fever is a systemic illness nearly always accompanied by arthritis and sometimes by skin rashes, carditis and neurological features [Sydenham's chorea]. The arthritis of rheumatic fever [sometimes called acute rheumatism, but not to be confused with rheumatoid arthritis] is an acute painful inflammation of one or several joints. There is commonly, but not invariably, a history of sore throat 2-4 weeks before the onset of joint symptoms. In adults, joint symptoms tend to be more prominent than carditis, while in children under six years the converse may be true.
Carditis, which usually occurs within a week or two of the onset of the arthritis, is the most important manifestation of rheumatic fever. It presents as palpitation, chest pain or breathlessness. There is usually a tachycardia and often cardiac enlargement. Cardiac failure may result either from impaired function of ventricular muscle or from mitral or aortic incompetence caused by valve damage.
A fever, leukocytosis and raised ESR are usual and non-specific , but useful for following the progress of the disease once diagnosed. The fever, in some cases, runs very high ; however in most cases the temperature is not more than one or two degrees above the normal. Culture of group A beta haemolytic streptococci from a throat swab, is positive in only a minority of cases by the time rheumatic fever is clinically manifest. Antistreptolysin O antibodies [ASO /titre] are useful evidence of recent streptococcal infection; but ASO titres are normal in about a fifth of adult cases of rheumatic fever. Echocardiography is useful for detecting cardiac dilatation and valve abnormalities.
Predisposition to this complaint seems to lie between the years of fifteen and forty. Early childhood and old age are generally exempt.
Case: 2. The Patient
She is our 57 year old dear mother; obese, mild, timid, very God fearing and genuinely philosophical . Has always suffered from eczema and vague aches and pains. She immensely loved sweets [3], eggs[3], fats[3] and icecreams[3], and always had profuse sweats all over, that invariably left indelible yellow stains. She had no problem with her menses but always suffered from early morning hurried diarrhoeas. Very hot and thirsty. Salivated [2] and uncovered her feet during sleep[3]. Generally dreamt of relatives who were dead long past. She had not a single tooth left since all of them had prematurely fallen off 10 years back.
Had faced many hardships in life with courage, but the recent passing away of my father after a prolonged sickness [whom she had devotedly served day and night with great love] and the consequent "not so pleasant" behaviour of some of her sisters-in-law, affected her immensely. She started brooding and weeping most of the time and tried to find some consolation in her religion and its philosophy. She drew her strength from her faith in God and thought it was her duty to be good to one and all, even to the 'not so pleasant' people.
But now gradually she started falling sick.
3] Derangement of the dynamis -OPD
She started losing her appetite. Along with it, gradually, she started having pain in her left knee joint, that increased in intensity with every passing day. Slowly, even her right knee started aching to some extent. No swelling, no heat, no redness. But the pain was excruciating [3] , shooting down to the toes, agg on motion [3] and somewhat amel. by external heat [2]
Around 10-12 days later, she developed symptoms of endocarditis with mitral insufficiency and she seemed to be going into CCF. Following were the symptoms:
Decreased urine output with oedematous swelling all over. Orthoponoea due to pulmonary congestion. P-120/m, feeble. T-100 * F, continuous B.P 130/80 mm of hg. Face cyanotic. Limbs cold. General pulsations. She felt whole left side of the body was very weak. Could not tolerate pressure of clothing around her chest. The condition seemed grave and something had to be done immediately.
4] Diagnosis and the subsequent management of the case:
Now I had a choice. Either I could call in my family pathologist and the cardiologist, get the case thoroughly investigated and get her rushed to the hospital, or stand up courageously with my unshaken faith in my science and give myself some time to wait and watch over carefully before I ridiculed my science with my failure. I opted for the latter.
As far as the diagnosis was concerned, though unusual at this age [but not impossible] , the typical presentation of the disease picture pointed strongly towards Rheumatic Carditis. So I first took the following totality:
a] Ailments from, grief [Sys3. p.4]
b] Delusions, wrong, suffered wrong; he has [sys p 82]
c] Delusions, neglected: duty; he has neglected his [Sys p 67]
d] Brooding [Sys p 24]
e] Heart, endocarditis, sepsis [Ph 4 , p 177]
f] Extremities, pain, rheumatic, left to right [Sys p 1218]
g] Chest, clothing agg [Sys p 1003]
h] Heart, mitral valve [Boger 5, p 254]
