Case-presentation: Ayurvedic Management of 'Mitral Valve Prolapse' (MVP).

 A Case Report: 

Ayurvedic Management of Mitral Valve Prolapse (MVP)

Author: Harshil Padhiyar, Megha Patel, Aishwarya Chaudhari, Anamika Soni, Surendra Soni.

Introduction

MVP is known with the synonyms as floppy valve syndrome, redundant cusp syndrome. It is one amongst the most prevalent cardiac valvular abnormalities. The clinical and echo cardio graphic criteria have been well established for its diagnosis. The most specific echo cardio graphic criterion is superior displacement of either or both the mitral valve leaflets by more than 2mm along its long axis above the annular plane. MVP is clinically recognized by the presence of mid-systolic click heard on auscultation.

MVP is classified as primary or secondary. Primary MVP is characterized by myxomatous degeneration of the valve in absence of any connective tissue pathology. Secondary MVP can be multifactorial and can be in with Ehler-Danlos Syndrome, Marfan’s Syndrome.

Clinically patient presents with chest pain and palpitations, it can also remain asymptomatic. Other symptoms such as anxiety, low blood pressure and syncope if present suggests autonomic dysfunction.

On echocardiogram, MVP is further divided to be of 2 types, Classic MVP and Non-Classic MVP on the basis of presence of morphological changes viz. thickness of the mitral valve leaflets.  In Classic MVP, mitral valve thickness is more than 5mm. In non-classic MVP variant mitral valve thickness ranges from 0-5 mm.

Classical MVP is further subdivided into symmetric and asymmetric form. In symmetric form the tip of both the leaflets meets at a common point on the annulus. Asymmetric form presents as any one leaflet displaced towards the atrium with respect to the other. The classical asymmetric form is further classified as of 2 types: Flail and Non-Flail Type. In the flail subtype, prolapse occurs when a leaflet turns outward viz. becoming concave towards the left atrium. The flail leaflet varies in prolapse from its tip eversion to rupture of the chordae tendineae. Dissociation of the leaflet from chordae tendineae leads to the unrestricted movement of the leaflet giving the name ‘Flail Leaflet’.¹

Treatment for the asymptomatic variant is usually not required. For symptomatic presentation of autonomic dysfunction, Beta Blockers such as propranolol are used. MVP with severe mitral regurgitation may be benefited from mitral valve repair or replacement. MVP carries a good prognosis usually. However, complications such as severe mitral regurgitation, infective endocarditis, stroke and sudden death can occur.

As per ayurveda, Hridaya is a marma sthana and is been regarded with the term Karnika. Since it is the central organ which connects shadanga, anga-vijnana, indriya and pancha indriyaratha.² It is made from the Kapha & Shonita Prasada.³ Hridaya can get affected by two kinds of pathologies viz. Santarpanjanya & Apatarpanjanya. In Apatarpanjanya pathology dhatu kshaya occurs and vata gets prakopa and leads to dhatu dushti of Hridaya. MVP is one among such disease as per mentioned principle.

In present case report, patient has personal history of Ati-chintana (Stress) and Anidra (Insomnia) as a prime cause. Acharya Charaka has termed this with Chintyanama Ati Chintanata as a cause of Rasavaha Srotasa Dushti.⁴ Habituation of the cause for sustained duration resulted in Vyakti of Vata Pitta Pradhana & Sleshma Kshaya - Tridoshajanya Dushti of Hridaya Marma - causing mitral valve prolapse. So patient was treated with treatment principles of Nidana Parivarjana, Vata Prashamana, Dhatu Poshana Chikitsa & Vyadhi Viprita Chikitsa.

 

Material and Methods

Patient Information

A 31 years male patient visited at OPD No. 4 at Govt. Akhandanand Ayurved College & Hospital, Bhadra, Ahmedabad on date 05/05/2023 with following complaints since last 2 months:

-         Aayase Vama Uraha Pradeshe Shula (Left sided chest pain on exertion)

-         Shiraha Shula (Headache)

-         Uthane Tamaha Pravesha (Black out on standing from sitting and lying down – Orthostasis)

-         Hridaya Spandana (Palpitations)

Patient was apparently healthy before 2 months, then patient developed left sided chest pain insidiously on and off on exertion, later after 2 months of occurrence of complaint patient was advised for 2D echo-cardiogram from SVP Hospital, Ahmedabad. In 2D echo the findings revealed mild mitral valve prolapse. Patient then approached for ayurvedic treatment at Kayachikitsa OPD No. 4 Govt. Akhandanand Ayurved Hospital, Ahmedabad.

Past History: None

Family History: Alzheimer’s Disease – Father.

Personal History:

-         Bowel Movement: 2 times/day

-         Micturition: 5 times/day

-         Appetite: Normal

-         Sleep: Disturbed

-         Vihara: Ati-chintana

Vitals:

-         Pulse – 84/min

-         Blood Pressure – 138/90 mmHg

-         Temperature: 98.4 F

 

Nidana Panchaka

·      Nidana:

·      Aharaja: Ruksha guna prayaha ahara.

·      Viharaja: Ati-chintana, Ratrijagarana/Anidra.

·      Anya: Absence of Ritu Shodhana.

·      Purvaroopa: Left sided chest pain (on and off) 2 months back.

·      Rupa: Ayase Vama Uraha Pradeshe Shula

           Shiraha Shula

          Uthane Tamaha Pravesha

          Hridaya Spandana

Samprapti Ghataka:

·      Dosha: Vata Pitta Pradhana & Sleshma Kshaya Tridoshajanya Hridroga

Vata Ruksha Guna Vriddhi – Pitta – Sadhaka Pitta Dushti – Sleshma - Avalambaka Kapha (Sneha & Sthira Guna Hani)

·      Dushya: Rasa, Rakta, Mamsa (Chordae Tendineae & Papillary muscles) & Meda (Myxomatous Degeneration)

·      Agni: Vishama

·      Srotasa: Rasavaha, Raktavaha, Mamsavaha & Medovaha

·      Srotodushti prakara: Sanga & Vimarga-gamana

·      Udbhava Sthana: Pakvashaya

·      Vyakti Sthana: Hridaya Marma

·      Vyadhi Svabhava: Chirakari

·      Sadhya-Asadhyata: Kricchra Sadhya

·      Sama/Nirama: Nirama

 

Investigation

Before : 2D – Echo.

Diagnosis: 

On the basis of clinical history, clinical presentation and 2D-Echo findings.

Treatment Given:

Patient was provided IPD care with Kala Basti Karma.

1.     Arogyavardhini Rasa - 2 TDS (post meal)

2.     Prabhakar Vati – 4 QID (post meal)

3.     Chandraprabha Vati – 2 BD (post meal)

4.     Ajamodadi Churna – 3 gm BD with Go Ghrita (Before Meal)

5.     Manjisthadi Kwatha – 40 ml BD (on empty stomach)

6.     Niruha Basti: Dravya

                        Dasha Moola Kwatha – 50 gm

                        Punarnava Churna – 50 gm

                       Arjuna Churna – 50 gm

                      Madhu – 40 gm

                     Lavana – 10 gm

                     Sneha (Tila Taila) – 40 ml

                    Kalka (Shatpushpa) – 40 ml

7.     Anuvasana Basti – Dhanvantara Taila – 60 ml

8.     Shirodhara – Ksheera (Milk)

 

Pathya – Apathya:

Mudga Yusha, Shaka (Patola, Karvellaka) as pathya.

Ratrijagrana, Vega Vidharana, Shrama (Exertion) as apathya.

2D – Echo (After Treatment)

Results

After 30 days of treatment, patient got complete relief in initial complaints. After 30 days of treatment 2D-Echo study had normal findings.

Follow up medicine:

Same as initial management.

Discussion

With growing urbanization and evolution of the lifestyle, changes in the pattern of health are seen in society. With the goal oriented and success centered mindset – competitiveness has increased which has led to several ailments to occur in the course of life. Often health problems initially are trivial and when being ignored turns into severe form of disease manifestation. It has been noted that with increase in health awareness among people, a trend of self-medication in the form of nutraceuticals and pharmaceuticals has emerged. Ayurveda emphasizes on the formation of the Doshas due to faulty life style. This Doshas as per their potential of pathogenicity produces signs and symptoms, which are often trivial with the faulty lifestyle habits. The emerging concept of nutraceuticals and easily available over the counter pharmaceuticals has led to time being aliment of these symptoms – this scenario leads to the formation of Leena Dosha as per Ayurveda.

Daily and Seasonal Regimen mentioned in the Ayurveda keeps the individual in a healthy state. Lifestyle evolution has led to negligence for following this basic rules of health. The practice of Ritu Shodhana mentioned in Ayurveda has also become obsolete nowadays. This has added the scenario of Leena Dosha in the normal physiology.

Present case as mentioned is one among such developing scenario of society. Patient had the problem with sleep (Anidra). Pratiloma Vayu is the key for development of various pathologies. In present case - Pratiloma Vayu is the initiator of this cascade of events. Anidra led disturbance in the normal optimal recovery of the body. This makes the Kshaya of Sthira and Snigdha Guna of Sleshma. Hridaya being Kapha Pradhana Avayava – it undergoes Kshaya – and gets vitiated by the Vikrita Vata and lastly the manifestation of Hrida Roga.

Treatment was mainly planned as per the principles of Nidana Parivarjana, Dosha Shamana, Dhatu Poshana and Vyadhi Viparita Chikitsa. Ajamodadi Churna with ghrita was given to induce Dipana & Pachana at Pragabhakta Aushadha Kala­ – to alleviate Vata Vriddhi which occurred due to Anidra. Arogyvardhini Rasa was added after meal to provide mild cholagogue effect along with Dipana & Pachana. Prabhakara Vati & Chandraprabha Vati both are Shilajatu enriched aushadha yoga and were the choice of drug in this case to achieve the foresaid principles of treatment. Prabhakara Vati is a well-known cardio-tonic while Chandraprabha Vati is known for its Srotoshodhana, Dipana & Pachana effect. Manjisthadi Kwatha was given as a liver stimulant. Basti was planned as a Balya to Pranavaha – Rasavaha Srotasa. Shirodhara was provided to aid sound sleep and reduce the Atichintana.

Conclusion

Management of Mitral Valve Prolapse can be treated with basic principles of Ayurveda like Dipana, Pachana, Anulomana, Srotoshodhana, Brimhana – if patients approach timely in early stage to the Ayurveda. 

_______________________________________________________________________

Harshil Padhiyar, Megha Patel, Aishwarya Chaudhari, Anamika Soni, Surendra Soni, "A Case Report: Ayurvedic Management of Mitral Valve Prolapse (MVP) Hridroga", IJRAR - International Journal of Research and Analytical Reviews (IJRAR), E-ISSN 2348-1269, P- ISSN 2349-5138, Volume.12, Issue 1, Page No pp.6-12, January 2025, 

Available at : http://www.ijrar.org/IJRAR25A1002.pdf

Please click link above to read full article.

Presented by

Vd. Harshil Padhiyar

B.A.M.S.

MD Scholar

PG Department of Kayachikitsa

Govt. Akhandanand Ayu. College,

Ahmedabad, Gujarat, India.

email- harshilpadhiyar72.hp@gmail.com

Mob.- +91 7874598969

Guided by

Prof. Vd. Surendra A. Soni

MD PhD (KC)

H.O.D.

PG Department of Kayachikitsa

Govt. Akhandanand Ayu. College,

Ahmedabad, Gujarat, India.