HEART FAILURE IS DEFINED AS THE PATHOPHYSIOLOGIC STATE INWHICH IMPAIRED CARDIAC FUNCTIONIS ARE UNABLE TO MAINTAIN AN ADEQUATE CIRCULATION FOR THE METABOLIC NEED OF THE TISSUES OF THE BODY.IT MAY BE ACUTE OR CHRONIC. AMONG THE VARIOUS DISEASES CAUSING HEART FAILURE, ISCHAEMIC HEART DISEASE SHARES A BIG PORTION. DEPENDING UPON WHETHER THE HEART FAILURE DEVELOPS RAPIDLY OR SLOWLY, IT MAY BE ACUTE OR CHRONIC. MOST OFTEN, HEART FAILURE DEVELOPS SLOWLY, AND MOSTLY DUE TO MYOCARDIAL ISCHAEMIA FROM ATHEROSCLEROTIC CORONARY ARTERY DISEASE. IN CHRONIC HEART FAILURE, COMPENSATORY MECHANISMS LIKE TACHYCARDIA, CARDIAC DILATION AND CARDIAC HYPERTROPHY TRY TO MAKE ADJUSTMENTS SO AS TO MAINTAIN ADEQUATE CARDIAC OUTPUT. THIS OFTEN RESULTS IN WELL MAINTAINED ARTERIAL PRESSURE AND THERE IS ACCUMULATION OF OEDEMA.

IN A LARGE EPIDEMIOLOGICAL STUDY IN 1967 COVERING 50 COUNTRIES OF ALL THE CONTINENTS, 37% OF ALL DEATHS WERE FOUND TO BE DUE TO CARDIOVASCULAR DISEASES, MOSTLY RELATED TO ATHEROSCLEROTIC CORONARY HEART DISEASE OR ISCHAEMIC HEART DISEASE.

ATHEROSCLEROSIS IS AN AGE-RELATED DISEASE. WHERE, BY THE AGE OF 60 YEARS THE INTIMA IS NEARLY AS THICK AS THE MEDIA. THE CHANGES UPTO THIS STAGE ARE NOT OF ANY DEFINITE PATHOLOGICAL SIGNIFICANCE, BUT ACCUMULATION OF FATTY DROPLETS IN THE INTIMA IS THE BEGNNING OF PATHOLOGICAL STATE OF ATHEROSCLEROSIS. AT ADVANCE AGE FIBROSIS OF THE MEDIA MAY UNDERGO HYALINE DEGENERATION. THE PHYSIOLOGIC CHANGES MAY BECOME PATHOLOGICAL, IF THE MEDIAL FIBROSIS IS SEVERE SO AS TO CAUSE LUMINAL NARROWING LEADING TO TISSUE ISCHAEMIA. THE ELASTIC TISSUE PRESENT IN THE ELASTIC LAMINA AND MEDIA UNDERGOES DEGENERATIVE CHANGES, WHERE IN INCREASE IN ELASTIN AND CALCIUM SALTS IS FOUND. BASED ON PREDOMINANCY, THUS, HYALINE, HYPERPLASTIC OR NECROTISING CHANGES ARE DISTINGUISHED. THE HYALINE IS A COMMON LESION, MAY BE SEEN PHYSIOLOGICALLY DUE TO AGING OR PATHOLOGICALLY IN HYPERTENSIVE AND IN DIABETICS. THE HYPERPLASTIC CHANGES ARE CHARACTERISTIC LESION OF MALIGNANT HYPERTENSION, HAEMOLYTIC-URAEMIC SYNDROME, SCLERODERMA AND TOXAEMIA OF PREGNANCY. NECROTISING CHANGES OCCUR IN VESSELS IN WHICH, THERE IS SUDDEN AND GREAT ELEVATION OF PRESSURE INJURING THE VESSEL WALLS.

ATHEROSCLEROSIS AFFECTS PRIMARILY THE INTIMA OF MUSCULAR ARTERIES AND IS CHARACTERISED BY FIBROFATTY PLAQUE [ATHEROMA], MOST COMMONLY AFFECTING THE AORTA, CORONARY AND CEREBRAL ARTERIAL SYSTEMS. THEREFORE, THE MAJOR CLINICAL SYNDROMES RESULTING FROM ISCHAEMIA DUE TO ATHEROSCLEROSIS ARE THE MYOCARDIAL INFARCTS [HEART ATTACKS] AND THE CEREBRAL INFARCTS. IT IS NOW WELL ESTABLISHED THAT HYPERCHOLESTEROLAEMIA HAS DIRECTLY PROPORTIONATE RELATIONSHIP WITH ATHEROSCLEROSIS AND HEART ATTACK. CHRONIC HYPERLIPIDAEMIA IN ITSELF MAY INITIATE ENDOTHELIAL INJURY AND DISFUNCTIONS BY CAUSING INCREASED PERMEABILITY. ON PROLIFERATED SMOOTH MUSCLE CELLS IN ATHEROMATOUS PLAQUE ONLY ONE FORM OF ‘GLUCOSE-6-PHOSPHTE DEHYDROGENASE [G6PD] ISOENZYME IS FOUND WHICH SUGGESTES MONOCLONALITY IN ITS ORIGIN SIMILAR TO CELLULAR PROLIFERATION IN NEOPLASMS.

IN CASE OF MYOCARDIAL ISCHAEMIA THE CHEST PAIN IS CENTRAL AND CRUSHING, WHICH MAY RADIATE TO THE JAW, NECK OR ONE OR BOTH ARMS. IT MAY ONLY BE FELT IN THE JAW OR ARM. IT MAY PRECIPITATE BY EXERTION, ANXIETY, COLD WEATHER AND HEAVY MEAL, AND MAY BE ASSOCIATED WITH DYSPNOEA AND FAINTNESS.IT IS RELIEVED BY REST AND NITRATE [ISORDIL]. IN ISCHAEMIA CAUSING IRREVERSIBLE NECROSIS OF PART OF THE HEART MUSCLE, ALMOST ALWAYS DUE TO CORONARY ATHEROSCLEROSIS, PAIN IS OF GREATER SEVERITY AND DURATION FOR OVER THIRTY MINUTES. IT ASSOCIATES WITH NAUSIA, VOMITING, SWEATING, AND EXTREME DISTRESS.PAINLESS [SILENT] INFARCTS ARE QUITE COMMON IN THE ELDERLY PEOPLES [MOSTLY AMONG DIABETICS]. PATIENT IS FOUND DISTRESSED, COLD, CLAMMY WITH TACHYCARDIA. BLOOD PRESSURE MAY BE UP OR DOWN. PATIENTS MAY DEVELOP CYANOSE, MILD PYREXIA, DYSPNOEA AND CREPITATIONS IN CHEST.\

TREATMENT OF THE ABOVE DESCRIBED CARDIAC PROBLEMS IS AVAILABLE, BUT IT IS DIFFICULT TO GET WITHIN TIME AND OF REQUIRED NATURE AS 50% DEATHS OCCUR WITHIN TWO HOURS OF ONSET OF THE SYMPTOMS. REMAINING PATIENTS MAY ALIVE FOR ABOUT A YEAR AND SO.

AS NOTED EARLIER, HYPERCHOLESTEROLAEMIA, SMOKING AND HIGH BLOOD PRESSURE ARE THE THREE PRINCIPAL RISK MARKERS OF THE ISCHAEMIC HEART DISEASE. PRIMARY PREVENTION ARE A FEW AND NOT DEPENDABLE. CHANGING LIFE- STYLE AND DIETARY MANUPULATION ARE SUGGESTIVE IN LOWERING LIPIDS. SOME LIPID LOWERING DRUGS ARE SUGGESTED. ALL ARE, PROBABLY, OF THE EYE WASHING VALUES.

AUTOPATHY TREATMENT ALONG WITH TREATMENT – ASSISTS HAS SHOWN VERY PROMISING OUT-PUTS AMONG PATIENTS WITH ABOVE DESCRIBED AILMENTS OF THE CARDIOVASCULAR AND METABOLIC DERANGEMENTS.PATIENTS WHO DID NOT DIE WITHIN TWO HOURS AFTER ONSETS OF THE MASSIVE MYOCARDIAL INFARCTION AND ARE PROSPETIVE TO SURVIVE ANOTHER ONE YEAR, ARE TO EXPECT VERY LONGER LIFE WITH MINIMAL ANNUAL MEDICAL CARE IF PUT ON AUTOPATHY MODE OF TREATMENT. [1] PATIENTS WHO HAVE DEVELOPED ESSENTIAL HYPERTENSION, BASICALLY AFFECTING CARDIOVASCULAR SYSTEMS, [2] PATIENTS WITH DERANGED LIPID-PROFILES AND HYPERCHOLESTEROLAEMIA, [3] PATIENTS WITH RECURRENT ANGINA PECTORIS AND [4] PATIENTS WHO HAVE WITHSTOOD FIRST MYOCARDIAL INFARCTION, ARE PROPOSED NOT TO DISCONTINUE ALLOPATHY TREATMENT, WHICH HAS BECOME A GREAT MATTER OF FAITH. ALONG WITH ALREADY PRESCRIBED / SUGGESTED ALLOPATHY TREATMENT ABOVE NOTED GROUPS OF PATIENTS ARE GIVEN 500 microgram TO 750 microgram OF AAA – THERAPY, SUBLINGUILLY FOR 45 DAYS, ALTOGATHER 90 CAPSULES ONLY.THEY ARE ALSO ADVISED TO TAKE ‘ONE TEA SPOON FUL POWDER’ OF CARDIAMOM MAGNA [COMFIT] THREE TIMES A DAY WITH HUNEY AND WARM / HOT WATER. ALONG WITH THIS SYMPTOMATIC TREATMENTS THEY ARE ALSO GIVEN [IF ALREADY NOT TAKING] NITRATE [ISORDIL] ANTIHYPERTENSIVE [NICARDIA], VITAMINS, TRANQUILIZER,DESPIRINE AND ANTIOXYDANT[ SAY, FREE CAD]. WITHIN THREE TO SIX MONTHS AFTER THIS AAA- AUTOPATHY TREATMENT THEY DEVELOP DRAMATIC IMPROVEMENTS- SYMPTOMATICALLY, PARA-MEDICALLY AND SOCIALLY TOO. GRADUALLY THE SYMPTOMATIC TREATMENTS ARE TAPPERED OFF. BY THE END OF NINE MONTHS AFTER THIS FIRST COURSE OF AAA – THERAPY, THE SECOND COURSE OF AAA- AUTOPATHY THERAPY IS GIVEN. NOW AND ONWARD, ONLY ANTIOXYDANT AND CARDIAMOM MAGNA THERAPY ARE CONTINUED. IF REQUIRED, OTHER SYMPTOMATIC AND SPECIFIC TREATMENTS ARE ALSO ADDED WITH. SYMPTOM FREE AND SOCIALLY REHABILATED SUCH PATIENTS SELDOM REPORT FOR FURTHER TREATMENTS. WHO SOEVER REPORT ARE PUT UNDER FULL ALLOPATHIC AND AUTOPATHIC PARAMEDICAL INVESTIGATIONS. IT IS INTERESTING TO NOTE THAT MANY ATHEROMAS WHICH WERE EARLIER FOUND GOT DISSOLVED / DISAPPEARED.IF REQUIRED, VERY SELDOM, AAA- AUTOPATHY WITH ANTIOXYDANT, CARDIAMOM MAGNA, AND OTHER SYMPTOMATIC TREATMENTS COULD BE PRESCRIBED. WE HAVE FOLLOW – UP CASES FOR OVER TEN YEARS AFTER MI AND AP WITH HYPERTENSION & HYPERCHOLESTEROLAEMIA. THEY ARE OFTEN FOUND FREE FROM ABOVE CARDIOVASCULAR AND METABOLIC PROBLEMS, AND HAVING VERY NORMAL LIVINGS & LIFE.