Cases of Cardiac Arrhythmia and Cardiac Failure
by Dr. Jyh-Sheng You
Center for Traditional Chinese Medicine, Chang Gung Memorial Hospital
Cardiac arrhythmia indicates irregularities of the frequency, rhythm, originating area of the cardiac impulse, conduction speed, and the order of excitement. The TCM terms “palpitation (Xin Ji) “ and “stirring heart palpitation (Xin Dong Ji)“ are similar to cardiac arrhythmia. A variety of causes may lead to symptoms such unable to act on one’s own. They are usually accompanied by chest tightness, shortness of breath, dizziness, and syncope. “Palpitation (Xin Ji) “ can be further differentiated into “palpitations due to fright (Jing Ji)“ and “severe palpitations (Zheng Chong)“. Palpitations that are caused by fright is termed Jing Ji and severe palpitations without any external stimulation is termed Zheng Chong.
The emperor and two of the minister herbs of Ginseng & Zizyphus Formula (Tian Wang Bu Xin Dan)
have the ability to nourish the heart and clam the spirit
Congestive cardiac failure is commonly caused by heart disease. It leads to severe cardiac compensatory insufficiency. Through recent clinical observations and experimental studies, most scholars believe cardiac failure is a pattern of deficiency in the root and excess at the exterior. Its pathological basis is heart Qi and Yang depletion. Its central pathological link is blood vessel stasis and stagnation. Blood stasis, turbid phlegm, and water-rheum are the patterns of exterior excess. Because excessive pathogens such as blood stasis, turbid phlegm, and water-rheum often manifest due to Zang-Fu depletion, we should reinforce healthy Qi to consolidate the root during treatments. Expelling and purging alone will damage the healthy Qi.
Case Studies and Treatment Process
[Case 1] Arrhythmia Case
Mr. Lee, 67-year old male retired farmer. Patient record number 1062XXX. Initial visit date: 07/31/2006
This patient was having on and off symptoms of palpitations for more than 10 years, which became aggravated over the last year.
1/02/2005: He began to have palpitations again (and went to our ER department). His energy level was fine however. April 2006: He went to the National Taiwan University (NTU) ER department due to palpitations, had regular follow-up appointments at the outpatient department, and took medication. He also had follow-up appointments at the outpatient department at Veterans General Hospital, where cauterization was suggested. There, he had cardiac catheterization performed, and there was no sign of narrowing or thrombus.
June 2006: He started to have more frequent palpitations, from once every four weeks to three weeks to every week. He would feel his heartbeats increase when bending, exerting strength, and doing exercises that stress the chest; sometimes he felt irregular heartbeats without any particular reason. He began to pant easily when going up and down the stairs or when doing slightly strenuous exercise. He would feel slightly panicked before the attack, but it was not induced by environmental stimulation such as noises. An attack was accompanied by chest tightness and throat constriction. They were usually aggravated when his health was compromised (such as lower back pain due to sprain, or having diarrhea for few days). Because his symptoms were worsening and more frequent, he was exhausted and weak. He sought treatment at many clinics and eventually came to our TCM department on 07/31/2006.
He had a history of hypertension for more than 10 years. (Although his blood pressure had not been high recently; it usually measured around 126~145/90~95mmHg. He had not been taking blood pressure medication regularly; he had only taken it when his systolic pressure was over 140 mmHg.) He had a history of a gout attack 5-6 years ago in which his blood uric acid level was high. It normalized subsequently and he never had another episode of gout. His height was 168cm, current weight was 77.5 kg (it was previously about 76kg), and BMI was 27.5.
His build was medium and slightly overweight. His facial complexion was withered yellow and pale. His lips, tongue, and nail beds were pale. He had bags under his eyes and dark circles. His tongue was light red and slightly dark with a thin, white coating and a deep vertical center crack. His pulse was deep and choppy.
01/02/2005: EKG (ER): Ventricular Premature Contraction (VPC)
01/03/2005: EKG RESTING sinus bradycardia
01/05/2005~01/10/2005: WRIST ECG RECORDER sinus rhythm with intermittent supraventricular tachycardia (187bpm)
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