How To Clinch A Diagnosis - A Short Case Of Acute Myocarditis - homeopathy360

How To Clinch A Diagnosis – A Short Case Of Acute Myocarditis

Dr Allwyn Pais

B.Sc. BHMS, M.D. (Hom)
Prof. And Head, Dept. Of Pathology and Microbiology
Yenepoya Homoeopathic Medical College and Hospital, Mangalore

  • A 23-year-old student presents to her general practitioner (GP) complaining of shortness of breath on exertion. This developed over the past 10 days, and she is now breathless after walking 50 yards. About 2 weeks ago she had a flu-like illness with generalized muscle aches and fever. She feels extremely tired and has noticed palpitations in association with her breathlessness.
  • In addition, she has some discomfort in her anterior chest which is worse on inspiration. Previously she has been extremely fit with no significant past medical history. There is no recent history of foreign travel. She denies substance abuse. On examination, her temperature is 37.5°C. Her pulse rate is 120/min and regular. Blood pressure is 90/70 mmHg. Jugular venous pressure is raised at 8 cm. On auscultation, there is a gallop rhythm, with a third heart sound. Examination of her chest is unremarkable. Pressure over the sternum causes discomfort. Abdominal and neurological examination is normal.

    Presenting Complaints
  • Shortness of breath on exertion.
  • Extremely tired.
  • Palpitations associated with breathlessness.
  • Discomfort – anterior chest, worse on inspiration. 

    History of Presenting Complaints
  • Presenting complaints since last 10 days.
  • Flu-like illness with generalized muscle aches and fever 2 weeks ago.
  • No recent history of foreign travel.

    Previous history of Illness
  • No significant past medical history.

    Social/Occupational history
  • Student
    Physical / General Examination
  • Temperature – 37.5oc
  • Pulse – 120/ minute and regular
  • Blood Pressure – 90/70 mmHg
  • Jugular Venous Pressure – 8 cms. (Normal 6 to 8 cms.)
  • On Auscultation – Gallop rhythm with a 3rd heart sound.
  • Pressure over sternum causes discomfort.
  • Abdominal Examination – Nothing abnormal detected
  • Neurological Examination – Nothing abnormal detected.

    Differential Diagnosis
    • Acute Myocarditis (Viral)
    • Cystic Fibrosis.
    • Congestive Cardiac failure
    • Pulmonary hypertension

      ( Pulmonary hypertension  may show signs of Right Ventricular Hypertrophy as “Tall R -Waves”)

      Case Evaluation is brief
  • Pulmonary hypertension ruled out because “No evidence of leg and ankle swelling on examination”. Chest x-ray and ECG – NORMAL (Pulmonary hypertension may show signs of  Right ventricular hypertrophy as “ Tall R- waves” in ECG )
  • Congestive cardiac failure ruled out because “No evidence of edema / swelling in the legs, ankles and feet; no cough or wheezing associated with phlegm.
  • Cystic fibrosis ruled out because “No history of childhood illness commonly seen in hereditary conditions of cystic fibrosis, no persistent cough or wheeze.

    Provisional Diagnosis

    Acute Myocarditis (Viral)
  • Shortness of breath.
    • Chest pain / discomfort.
    • Irregular heart beat (Gallop rhythm) causing palpitations.
    • Increased pulse rate (tachycardia) due to viral infection or bacterial infection.
    • Age factor ( Affects the young mostly)

      Final Diagnosis

  • Homoeopathic Remedies for Myocarditis
    1. Arsenic  Iodatum
  • Great emaciation
    • Cardiac weakness
    • Anemic Palpitation and Dyspnoea.

      2.   Carbo Vegetabilis
  • Oppressed and quickened respiration.
    • Effects from previous illness.
    • Sore and raw chest.

      3.   Digitalis
  • Weak and dilated myocardium
    • Irregular respiration.
    • Prostration from slight exertion.

      4. Kali Carbonicum
    • Generalised weakness characteristic of all potash salts.
    • Sensation as if heart were suspended.
    • Palpitation and burning in the region of heart.

      5. Phosphorus
    • Nervous debility and emaciation in youngsters.
    • Great Violent palpitations with anxiety.
    • Respiration oppressed, quickened with tightness across chest.

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