Case No.- 1
A 64-year-old male from Rajasthan, a known case of Diabetes Mellitus for the past 8 years, presented on 21-11-2024 with symptoms suggestive of cardiac, respiratory, and gastrointestinal involvement. His Chief complaints included.......
left-sided chest pain,
cough with sputum worse at night,
radiating pain from the left shoulder to the arm and forearm,
abdominal distension,
headache,
heaviness in the head,
constipation,
and disturbed sleep.
He also reported frequent urination (15–20 times/day)
and had a history of alcohol, tobacco, Ganja etc use.
Initial Clinical Status
On examination (27-11-2024), his vitals showed:
- BP:
160/96 mmHg
- Pulse:
96/min
- No
cyanosis, clubbing, icterus, or edema
Laboratory & Cardiac Investigations (Before
Treatment)
- Hb:
11.8 g/dl, ESR: 64 mm/hr
- Random
Sugar: 137 mg/dl
- HbA1c:
7.92%
- Troponin:
Positive (118.8 ng/ml) — indicating acute myocardial injury
- ECG:
Changes suggestive of Acute Coronary Syndrome (ACS)
2D Echo (21-11-2024)
- LVEF:
40%
- Mid
& basal anterior, anteroseptal and apical wall hypokinesia
- Moderate
LV systolic dysfunction
- RWMA
consistent with ischemic cardiomyopathy
- Mild
physiological MR/AR
Coronary Angiography
- RCA:
70–80% stenosis
- LAD:
90% diffuse disease
- Advised
CABG/PTCA
Diagnosed as Acute coronary syndrome
The patient was diagnosed with Madhumehottara Kaphaja
Hแนidroga from the Ayurvedic perspective.
Ayurvedic Management
The patient was admitted for 28 days in the IPD of the
PG Department of Kayachikitsa and treated with a combination of Shamana and Shodhana
Chikitsa.
Clinical Outcome After 28 Days
The patient reported marked improvement in chest
discomfort, breath-related symptoms, shoulder–arm pain, digestion, sleep, and
bowel habits.
Repeat 2D Echo Findings (After Treatment)
- EF
improved from 40% → 58%
- No
Regional Wall Motion Abnormality (RWMA)
- Significant
restoration of LV systolic function
Interpretation
The improvement in LVEF and resolution of RWMA
indicate substantial recovery of myocardial function. While myocardial stunning
after ischemic injury can naturally recover over time, the patient’s Ayurvedic
protocol appears to have contributed significantly to symptomatic improvement
and overall functional recovery in this case.
Case No.- 2
A 38-years old male was admitted on 23 June 2025 with Chief complaints of.......
intermittent chest pain for four months,
increasing breathlessness on exertion,
palpitations,
anxiety,
restlessness,
general weakness,
abdominal discomfort,
and constipation.
His sleep was disturbed due to anxiety and chest pain, although appetite was normal. On examination, he appeared anxious and dyspneic, with a pulse of 86/min and high blood pressure (160/110 mmHg). The patient had a known history of DM, Coronary Artery Disease with an Anterior Wall Myocardial Infarction and had undergone PTCA with two stents placed in the LAD on 12/04/2023.
Investigations showed severe LV
systolic dysfunction (EF 25–30%), ECG changes of ischemia, and elevated
triglycerides, uric acid, and liver enzymes. Ayurvedic diagnosis was made as Uccha
Raktachapa and Madhumehaja Hridroga. Allopathic medications were
tapered and stopped and the patient was managed completely
with Ayurvedic treatment for 15 days in the PG Kayachikitsa IPD. Through a
combination of Shamana and Shodhana treatment.
Diagnosis:Uchha-Raktachapa/Madhumehaja Hridroga
After completion of the Ayurvedic treatment, the
patient showed significant improvement in cardiac function. The heart’s pumping
capacity (Ejection Fraction) improved from 25–30% to approximately 45%,
indicating recovery of left ventricular function. Importantly, the heart
chambers are not dilated, which is a positive prognostic sign suggesting that
structural deterioration has been prevented.
A small amount of regional wall motion weakness
persists, which is expected due to the previous heart attack, but overall
cardiac performance has improved. There are only mild valve leaks, which are
not clinically severe and do not pose major concern.
No high-risk complications such as cardiac clot,
pericardial effusion, or severe pulmonary artery hypertension were detected.
Overall, the post-treatment status reflects better heart efficiency, improved
stability, and reduced cardiac risk compared to the initial presentation.
Case No. 3
A 79-years old male was admitted on 3rd September 2025 with Chief complaints of.......
dyspnea,
chest pain,
cough with sputum,
dry throat,
weakness,
and reduced appetite.
K/C/O- DM 30 years, HTN-6/7 Years
Personal History:
Appetite: Normal,
Sleep: Increased,
Urine- 5-6 times in day, 1-2 times in night,
Bowel: 1 time in day- On off
Constipated
Past History – Pulmonary TB
30 Years ago
On Admission Vitals-
BP: 98/60 mm of Hg, PR- 82/min, RR- 30 min, RBS- 360 mg/dl
Biochemical investigations
revealed very high Troponin-I (5399.5 pg/mL), elevated CRP, severe
hyperglycemia (HbA1c 10.32%), and mildly impaired renal function. Echocardiography
showed severe left ventricular dysfunction with an EF of 25%, regional wall
motion abnormalities, moderate MR, mild TR, reduced LV compliance, and mild
pericardial effusion.
#DrugHistory:
Insulin Glargine – 15 unit, Anti diabetic/OHA, Atorva+Aspirin, Pantop,
Metoprolol, Spironolactone+ Torsemide
The patient was diagnosed with Hridaroga/
Madhumeha/ Uccha Raktachapa and managed completely with Ayurvedic
treatment after tapering all allopathic medications.
Diagnosis: Hridaroga/ Madhumeha/ Uchha Raktachapa
Before Treatment:
After Treatment:
Pt was admitted in IPD of PG Kayachikitsa department
for 40 days and after 40 days Subjectively and objectively patient gets
significant relief. As after Rx: The
heart function has improved significantly between the two ECHOs — from EF 25%
with wall motion abnormality to EF 45% with no RWMA, No Pericardial effusion, Minimal hypokinesia and Mild MR only, This suggests recovery of heart muscle
function by Ayurved treatment & resolution of ischemic insult.
Troponin normalized to 0.02 ng/mL, respiratory
symptoms resolved, strength improved.
Patient’s Insulin was tapered down completely to zero
dose before end of treatment.
Case No. 4
A 61-year-old female patient was admitted on 13 August 2025 with Chief complaints of
dyspnea on exertion (Gamane–Shrame Ayase Shwas Kashtata),
nocturnal breathlessness, dry cough,
anxiety,
restlessness,
generalized weakness,
fatigue,
and intermittent giddiness.
K/C/O- Type 2 Diabetes Mellitus for 20
years.
Her appetite was decreased, sleep was disturbed, and
she experienced constipation with hard stool.
On general examination,
her pulse was 80/min, BP 120/60 mmHg, respiratory rate 24/min, and SpO₂ 96%.
Biochemical investigations
between 14/6 and 28/6/25 showed dyslipidemia with elevated total cholesterol
(219.62 mg/dL), triglycerides (197.52 mg/dL), LDL (134.30 mg/dL), and VLDL (38
mg/dL), along with moderately controlled diabetes (HbA1c 6.8%, FBS 126.9 mg/dL,
PPBS 157.5 mg/dL).
Renal parameters were slightly raised with creatinine
1.29 mg/dL and BUN 33 mg/dL.
Chest X-ray
revealed fibro-calcified changes with partial volume loss in the left upper
lobe and mild cardiomegaly.
HRCT thorax
showed patchy ground-glass opacities with smooth interlobular septal thickening
indicating congestive changes, along with fibro-calcific and
fibro-bronchiectatic changes in the left lung and bilateral pleural effusion.
2D Echocardiography
revealed dilated LV, severe LV dysfunction, generalized LV hypokinesia, dilated
LA, mild MR and TR, trivial AR, mild pulmonary arterial hypertension, reduced
LV compliance, and a markedly reduced LVEF of 20%. CAG demonstrated
single-vessel disease.
Based on clinical and diagnostic findings, the
condition was diagnosed as Madhumehottar Hridaroga(Vatik).
Before Treatment:
Patient was admitted in IPD of PG Dept of
Kayachikitsa and got significant relief in subjective and objective both
criteria with increase in LVEF from 20 % to 30- 35%.
Case No.- 5
A 55-years old male patient, known hypertensive with Coronary artery disease and employed in the GST department, presented to the OPD with chief complaints of.......
constipation,
dyspnea on exertion,
and intermittent chest pain.
The patient also had a past surgical history of
fistula-in-ano. He was on
ongoing medication with Aspirin and Enalapril at the time of presentation.
Clinical Findings
On clinical evaluation, the patient reported
progressive exertional breathlessness and episodic chest discomfort, associated
with long-standing constipation. Cardiovascular examination suggested reduced
exercise tolerance, while abdominal examination was unremarkable except for
sluggish bowel movements.
Investigations
1. Coronary Angiography
- LMCA:
Distal segment showing 20% lesion
- LAD:
Long segment 80% lesion after the origin of the D1 branch
- LCX:
Presence of ostial plaque
- RCA:
Dominant vessel with 30–40% proximal lesion, followed by mild mid-segment
involvement
2. 2D Echo with Color Doppler
· LVEF:
45–50% (borderline low / mildly reduced)
· Apical
septum hypokinesia (weak movement)
·Septal
movement abnormality suggestive of LBBB
· LV
compliance reduced
· Concentric
LVH
· Mild
tricuspid regurgitation
· Aorta
29 mm, LA 32 mm (normal)
· RVSP:
33 mmHg
Diagnosis
Based on the clinical presentation and investigations,
the patient was diagnosed with:
- Coronary
Artery Disease (CAD) with significant LAD involvement
- Hypertension
with concentric LVH
- Mild
LV systolic dysfunction
- Functional
constipation
Treatment Course
The patient was admitted to the PG Department of
Kayachikitsa and managed for 17 days with exclusive inpatient care. Treatment
included regulation of bowel habits, supportive management for dyspnea and
chest discomfort, optimization of cardiovascular function, and taper and
stoppage of prescribed allopathic medications (Aspirin and Enalapril).
Ayurvedic interventions were tailored to improve digestion, enhance cardiac
function, and reduce overall symptom burden.
Outcome
Following 17 days of inpatient treatment, the patient
demonstrated significant symptomatic relief, with marked improvement in:
- Episodes
of dyspnea
- Frequency
and severity of chest pain
- Constipation
- Overall
functional capacity
Objective improvement was noted in cardiovascular
parameters and general well-being at the time of discharge.
After Ayurved treatment for 17 days 2D Echo shows
significant improvement:
·
LVEF: 55% (NORMAL)
·
No RWMA (normal wall motion)
·
No significant LVH (IVS/PW 8 mm, normal
thickness)
·
No pericardial effusion
·
Aorta 23 mm, LA 28 mm (both normal)
·
RVSP: 22 mmHg (normal)
·
Only trivial MR, AR, TR (very mild
and normal)
After Treatment:
Management:
1. Out of 5, there was 4 cases had Chronic DM with its complications esp. Cardiac involvement so all the patients were given available 'Deepan', 'Pachan' & 'Anuloman' in 'Apan-kal' with available drugs in IPD Dispensary like 'Shivakshar-pachan-churna'/'Hingvashtak-churna' or 'Ajamodadi-churna'. Chandraprabha-vati, Mahasudarshan-ghan-vati, Mamejava-ghan-vati were given 2 BD and Kanyalohadi/rajah-pravartini-vati were given after meal. Available Kwath-preparations either Dashmool/manjishthadi or guduchyadi were served readymade in 40 ml dose BD. Siddha-pran-sudha-kalpa & Yogendra/Basant-kusumakar-ras were given in 1 BD dose with 30 ml milk as 'Hrid-balya(Cardiac-tonic). All patient were given 'Hrid-vasti' with Mahavishgarbh-tail for 20 min. In panchakarma procedure, 'Kal-vasti' regimen was given with mentioned above 'Kwaths' whichever is available with 'Niruh-vasti' protocol and 'Anuvasan-vasti was given with 'Mahakalyanak/Mahatifala ghrit'. 1 nondiabetic patient was also administered the same management except 'Mamejava-ghan-vati' etc. All patients got affected with seasonal changes and opportunistic infection which was treated accordingly with available IPD drugs. All patients were asked & ascertained to follow the advised diatary-restrictions as per the conditions. All the patients who were on allopathic drugs or insulin, shifted to Ayurvedic management gradually by tapering the drugs & later on stopped.
The whole treatment was selected on the basis of Madhumeh, Udavart & Vatik 'Hrid-rog' lines of management targeting the correction of Agni(Mahasrotas/GIT) with available 'Deepan' & 'Pachan' & 'Anuloman drugs'. In the Condition of excessive 'Dhatu-kshay' in presence of Chronic DM, pathogenesis progressed from 'Koshtha' to 'Shakha' & up to the level of 'Hrid-marma' so the vasti-regimen & 'Vyadhi-pratyanik-ras-preparations' were also advised and desired 'Upashay' could be obtained. This was the collective team work by all P.G.K.C. Scholars & interns who executed the quality 'Panchakarma' procedures individually.
UPDATED
Case no. 6
-Patient Profile
A 46-year-old male with a history of hypertension (since 2016), type 2 diabetes mellitus (since 2025), and past cerebrovascular accident (left-sided hemiplegia). He presented with exertional dyspnea (Grade I–II), chest pain, and generalized weakness.
-Baseline Cardiac Status
-
Cardiac MRI showed LVEF 28%.
-
2D Echo (08/01/2026) showed LVEF 35%.
-
LAD territory akinesia with regional wall motion abnormality (RWMA).
-
Moderate left ventricular (LV) dysfunction.
-
Coronary angiography revealed significant CAD (LAD 80% stenosis, RCA 90% stenosis).
-
Cardiac MSCT showed a large apical aneurysmal bulge with layered clot.
-Ayurvedic IPD Management
The patient underwent Ayurvedic management for 19 days in the IPD of the PG Kayachikitsa department with a holistic approach targeting cardiac function, systemic strength, and metabolic balance.
-Improvement in Ejection Fraction
Post-treatment evaluation showed significant improvement in cardiac pumping power:
-
EF improved from 35% → 55%
-
55% EF falls within the near-normal range, indicating marked systolic recovery.
-Resolution of Wall Motion Abnormality
-
Earlier: LAD territory akinesia present.
-
After treatment: No RWMA at rest, suggesting substantial myocardial functional recovery.
-Improvement in LV Function
-
Earlier: Moderate LV dysfunction.
-
After treatment: Improved to fair LV function, indicating meaningful reversal of cardiac impairment and overall functional enhancement.
Patient got significant relief subjectively and objectively both.
Case no. 7
-Patient Information
A 75-year-old female patient presented with complaints of exertional chest discomfort, dyspnea and generalized weakness. She was a known case of hypertension since 10 years and had been newly diagnosed with Type 2 Diabetes Mellitus since the past 2–3 months.
-Diagnosis at Admission (22/11/2025)
The patient was diagnosed with Acute Coronary Syndrome, specifically Inferior Wall Myocardial Infarction (NSTEMI).
-Baseline Investigations (Before Admission)
2D-Echocardiography Findings
-
Left ventricular ejection fraction (LVEF): 40%
-
LAD territory hypokinesia
-
Moderate mitral regurgitation
-
Trivial aortic regurgitation
-
Trivial tricuspid regurgitation
-
No pericardial effusion
These findings indicated moderate left ventricular systolic dysfunction with regional wall motion abnormality.
Cardiac Biomarkers
-
CPK-MB: 113 U/L (elevated)
-
Troponin-I: 7448 pg/ml (markedly elevated)
These values confirmed acute myocardial injury.
Metabolic Profile
-
Total cholesterol: 256 mg/dl
-
Triglycerides: 333 mg/dl
-
HDL: 32 mg/dl
-
HbA1c: 10.8%
The profile suggested poor glycemic control and an atherogenic lipid pattern.
The patient was admitted in the IPD of PG Kayachikitsa, Government Akhandanand Ayurved College, Ahmedabad for further management and monitoring.
-Follow-Up Assessment (29/01/2026)
Repeat 2D-Echocardiography Findings
-
LVEF improved to 45%
-
Mild LV systolic dysfunction
-
Normal LV and LA size
-
No LVH
-
No clots or vegetations
-
No pericardial effusion
-
Mild mitral regurgitation
-
Trivial aortic regurgitation
-
Mild tricuspid regurgitation
These findings indicated improvement in left ventricular systolic function without structural deterioration.
Cardiac Biomarker Improvement
-
CPK-MB reduced from 113 U/L to 13 U/L (within normal range)
This suggests resolution of acute myocardial injury.
-Clinical Outcome
On comparative assessment, the patient demonstrated clear objective and clinical improvement. The left ventricular ejection fraction improved from 40% at baseline to 45% on follow-up, indicating recovery of systolic function. The previously noted LAD territory hypokinesia showed functional stabilization without progression. Cardiac enzyme levels showed marked normalization, with CPK-MB reducing significantly from 113 U/L to 13 U/L, reflecting resolution of acute myocardial injury. The severity of mitral regurgitation decreased from moderate to mild, while trivial aortic and mild tricuspid regurgitation remained stable without worsening. Importantly, there was no development of left ventricular hypertrophy, chamber dilatation, clots, pericardial effusion, or signs of heart failure. Clinically, the patient reported approximately 80% relief in breathlessness and generalized weakness. Overall, the follow-up findings indicate functional cardiac recovery, biochemical normalization, and significant symptomatic improvement without structural deterioration.
Dr. Shubham Tripathi
B.A.M.S.
MD IInd Yr. Scholar
P. G. Dept. of Kayachikitsa
Govt. Akhandanand Ayu. College, Bhadra, Ahmedabad, Gujarat, India
Mob.- +91-6260097626
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Excellent Presentation. Congratulations
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