Ms. A: 55 years old
The patient was first seen on 23/8/2021. She caught a cold after returning to Hong Kong in August 2021 and is still short of breath and coughing. After treatment, the cough stopped, but she still had shortness of breath and chest tightness, which worsened when climbing stairs. She had high blood pressure (refusing to take antihypertensive drugs) and diabetes in the past. Her blood pressure in the clinic was 170-180, and he occasionally had shortness of breath, chest tightness, and dizziness. As the patient had been away from Hong Kong for a long time in the past, he has been arranged to be admitted to the hospital for a detailed physical examination.
The electrocardiogram in September 2021 (above) showed 1) sinus rhythm, 2) left ventricular hypertrophy, 3) T wave inversion in leads I and aVL, which is an abnormal electrocardiogram. Thyroid cyst, normal thyroid metabolism, and hyperthyroidism are excluded. Pulse: stringy, pale tongue with thick yellow fur, sticky stool.
Treatment: Treatment once a week mainly uses acupuncture, Chinese medicine, and cupping to achieve the goals of balancing yang (liver), replenishing qi (heart and lungs), removing blood stasis, promoting diuresis, and dispersing nodules (thyroid gland).
The patient's family doctor had prescribed three antihypertensive drugs, but she advocated Chinese medicine treatment once a week, so she only took one of the antihypertensive drugs (Exforge 12mg once a day).
The ECG (below) in December 2022 showed: 1) sinus rhythm, 2) T wave inversion in lead I and lead aVL. The ECG was close to normal, and the symptoms of shortness of breath and chest tightness were greatly improved. The blood pressure in the clinic was about 150/70.
Update: Patient adheres to medication, November 2024: average blood pressure 130-140/ 60-70 heart rate 60-70 per minute. Forgets to take medication 1-2 times a week, but blood pressure is stable. The next step is to reduce the dose of blood pressure medication.
Analysis: This patient has a history of hypertension, occasional shortness of breath and chest tightness. It is related to cardiopulmonary function. However, after the lung infection was cured, the problem of shortness of breath and chest tightness still existed, which can be judged to be related to the heart. The electrocardiogram results showed left ventricular hypertrophy, plus the T wave inversion of the lateral wall lead. The inverted T wave indicates myocardial ischemia (because the electrocardiogram report does not provide analysis, the doctor must be able to interpret the electrocardiogram to reach this conclusion).
Long-term lack of oxygen and blood supply to the myocardium may lead to angina or even myocardial infarction. Therefore, both Chinese and Western medicine must adopt methods such as lowering blood pressure, unblocking blood vessels, and promoting diuresis to reduce the myocardial load. This case suggests that Chinese medicine practitioners must have the ability to interpret medical reports and have a certain understanding of the development of diseases. Treatment based solely on shortness of breath and chest tightness cannot always be implemented on the function of the heart. If combined with instruments such as measuring blood pressure and electrocardiograms, Chinese medicine practitioners can move from overall syndrome differentiation (four diagnoses) to microscopic syndrome differentiation (myocardial, cardiovascular) to improve the efficacy of treatment.
How to microscopically diagnose? Myocardial hypertrophy must be accompanied by blood stasis and edema, so the treatment is mainly to remove blood stasis and edema; for myocardial ischemia, it is necessary to increase oxygen and blood supply first, mainly to replenish the heart and lung qi and blood, and to calm the liver yang, that is, to lower blood pressure (to achieve synergistic effects with Western medicine antihypertensive drugs), to enhance the treatment effect. The patient persisted in the treatment, and the electrocardiogram report after 1 year was BORDERLINE ECG, showing that myocardial hypertrophy and blood supply had improved, and was equipped with Chinese medicine for half a year before leaving Hong Kong in March 2023 to consolidate the treatment effect.
In summary, when Chinese medicine practitioners diagnose and treat patients (differentiation of syndromes), they can combine modern test results with a certain understanding of heart disease (differentiation of diseases), which can improve treatment outcomes and reduce reliance on medication.
# Chinese Medicine Heart Health
# Chinese medicine for high blood pressure
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