DEFINITION: -
Cardiovascular disease means Heart Disease.
Heart is a vital organ in the body; hence any disease affecting this organ is of a serious nature.

ETIOLOGY: -
Consumption of food having heavy, dry, bitter and astringent qualities, worry, excessive exercise, withholding natural urges, stress and strain, misuse of purifying procedures and external injury are the main causative factors.

TYPES: -
Five types have been described.
Vataja, Pittaja, Kaphaja, Tridoshaja and Krumija.

AYURVEDIC PATHOGENESIS (SAMPRAPTI): -
Yo. R. Hridrog Nidanam shloka- 2
Cardiovascular Disease from an Ayurvedic perspective can be classified into:

1. Causes which directly affects the Heart.
2. Causes which are important for maintaining physiological functions of the Heart.
3. Cardiovascular Disease as a complication of other diseases.

These would be classified as being imbalances of –

1. Vata,
2. Pitta,
3. Kapha,
4. TriDoshas (all three Doshas) or
5. Parasites, Viruses, Worms, Bacteria (Krumi).

The etiological factors are generally classified as psychological factors, diet, activity, excessive sexual indulgence, suppression of natural urges, alcohol in excess, bacteria, viruses, worms and other toxins, iatrogenic causes, effects of drugs, improper management of disease, abnormal or excess use of emetics, purgatives or enemas, trauma to the Heart, complications of other diseases.

These will cause abnormal increase or decrease in Vata, Pitta and Kapha and in turn Rasa which enters the Heart and give rise to the Cardiovascular Disease. The various factors which lead to the different types of Cardiovascular Disease.

In summary, the Eight basic elements that maintain the integrity of the cellular structure and functions of the Heart are- Rasa, Rakta, Mansa, Ojas, Prana Vata, Vyana Vata, Sadhaka Pitta, and Avalambaka Kapha.
In Ayurveda the Pathogenesis provides insights into the development of the disease process, showing in detail how the Doshas when aggravated by certain etiological factors affect the Dhatus and Srotas of the body, eventually manifesting in disease.

Ayurveda describes the following types of pathogenesis of Cardiac Disease.

DERANGEMENT OF RASA DHATU: -
Rasavaha Srotas Dusti Hetu: - (Ch. Su. 28/8-10)
The following can be seen as the interpretation of the Samprapti of Cardiovascular Disease.

1. Vitiation of Doshas,
2. Accumulation of Vitiated Doshas and Vitiated Rasa Dhatu in the Heart.
3. Development of Obstruction in the Heart and impairment of physiological function of the Heart.

Thus, due to the impairment of nutrition of the cardiac muscle (by Rasa) the outcome is some sort of Cardiovascular Disease.

ORGANIC CHANGES: -
Organic changes in the structure of the Heart by the formation of the nodules lead to the distortion of normal structure of the Heart. This may result in a build-up of fluid. Various pathogenic organism are likely to grow in this area, which may cause obstruction in the cardiac region. Thus the development of Krimi. Cardiovascular Disease which results in growths / tumours in parts of the Heart. These can continue to grow, along with the Krimi which can eventually attack the entire Heart causing severe pain and may lead to death.

ROLE OF VITIATED DOSHAS: -
Doshas become vitiated by the continual cycle of incorrect lifestyle and diet (Nidana).
Yog. R. Hridroga Nidanam Shloka -1
In Cardiovascular Disease, the aspects of Doshas that are vitiated are Prana Vata, Vyana Vata, Sadhaka Pitta, Avalambaka Kapha.
In the early stage of the disease, Kapha, is in Amashaya (Stomach & duodenum), Pitta in Grahani and Vata in Pakwashaya (colon).
In the later stages the vitiated Doshas vitiate the Heart.
Ama (toxins) created by undigested food) causes blockages in places in the body where they have a predisposition to settle in. Ama is produced by Agnimandya – a decrease in the digestive fire or metabolism,which is the cause of leaving food undigested, creating toxins.
The Ama, if left to continue to grow will eventually, exploit whatever weakness is there in the body. First it manifests in the G.I.T. and hollow organs, in the particular part where Dosha which are vitiated lives.
However as the Ama increases it will start to move into the bodily tissues i.e. Dhatus, first entering into Rasa and then eventually into Rakta etc.
When it has entered Rasa, it will affect the organ that is the seat of Rasa, the Heart and eventually weaken the sub-Doshas of Prana Vata , Vyana Vata, Sadhaka Pitta, Avalambaka Kapha and Ojas.
The reason Heart is affected in some people rather than everyone is because there is an inherent weakness at this level. Such weakness (Khavaigunya) will attract Ama and block this major channel in the body.

DEVELOPMENT: -
Once the condition reaches stage ΙΙΙ ( Sthana Samsharaya ) the symptoms of Cardiovascular Disease appear clinically. During this process the deformities in the Rasavaha Srotas are well established and there is an excess flow ( Atipravritti ) or growth ( Granthi ) established in the Heart region which will cause the Dosha or Dhatu to increase or decrease.

If the proper treatment of Cardiovascular Disease ( Hridroga ) is not followed and the causative factors are continued the Doshas in the Heart become more and more vitiated along with the development of various complications . This condition is called “ Bheda Avastha”.

In this condition the circulation of Rasa-Rakta may be affected and is also called “ Marma- Upaghata”.

GENERAL SYMPTOMS: -
Cyanosis or any other changes in the color of the skin, fainting and mild fever are initial symptoms. Cough, Hiccup, Breathlessness, improper taste to the food, thirst, improper functioning of the sense organs appear later. Then vomiting, cough with expectoration, pain in and around the region of the Heart becomes prominent.

SIGNS & SYMPTOMS OF HEART DISEASES: -
Angina
Dryness
Dyspnoea
Exertional Fatigue
Sweating, Heaviness in the chest, Left shoulder pain

AYURVEDA: -
The symptoms differ and give an indication of what type of Cardiovascular Disease we are looking at.

VATAJA SYMPTOMS: -
Ch. Su. 17/31
Ch. Chi. 26/78
Yog. R. Hridroga Nidanam shloka 3

Various types of pain are the main symptoms because of Vata affecting the Heart. Palpitation, Change in the sounds of the Heart, Irregular Pulse, and Breathlessness may accompany this type. Usually there is sudden onset pain in the chest, which is more prolonged than angina pain. This pain remains for at least 30 min and is not relieved by rest. The pain is very severe with a sensation of crushing or compressing like a vice or a heavy band across the chest. The pain can be of throbbing or breaking type, radiating to the left hand or jaw. Many a times there is only sence of suffocation or gripping in the chest.

Aacharya Sushruta, Yogaratnakar have adviced to give medicated emesis for treating this disorder, in those patients who have good strength. However if the patient is weak, one can carry out simple stomach wash also.

Another symptoms are severe pain, convulsions, stiffness in the chest, feeling of emptiness in the chest, pricking pain, dry feeling inside the chest, edema, sudden attacks, aversion to loud sounds, breathlessness, insomnia and twitching pain, Malnutrition of the organs, particularly in old age, make the tissue of the Heart dry, tense, shrunken, shortened, rough and hard. Irritability, exhaustion or inability to cope with emergency demands cause spastic contractions or rapidity of contraction and produce pain and fatigue in a short time-frame and depletion of body fluids may all provoke Vata.

PITTAJA SYMPTOMS: -
Ch. Su. 17/33
Ch. Chi. 26/79
Yog. R. H. N. Shloka 4
Pittaja Symptoms include Heart burn, persistent bitter taste, sour and bitter belching or burning, tiredness, thirst, partial or complete loss of consciousness, excessive sweating, fever, yellowish colouration, frightened, restless, darkness before eyes, vertigo, vomiting, dryness of mouth, and severe burning sensation. Inflammatory changes leading to tissue destruction and high fever.

KAPHAJA SYMPTOMS: -
Ch. Su. 17/ 34
Ch. Chi. 26/80
Yog. R. H. N. Shloka 5

It includes numbness or heaviness in the Heart, drowsiness, anorexia, nausea, fever, cough, feeling of a stone in the Heart, excessive sleep, laziness, persistent sweet taste, vomiting and chest pain. Increase in size and shape making the Heart heavy, sluggish and flabby due to deposits of Fat ( Meda ) or Hypertrophy ( Mansa).
Drying and density of Rasa Dhatu produces obstruction and prevents free movement. Thickening and hardening of the arteries will occur.

TRIDOSHAJA SYMPTOMS: -
Ch. Su. 17/35
Ch. Chi. 26/80
It will be a combination of the above.

KRIMIJA SYMPTOMS: -
Ch. Su. 17/ 39-40
Ch. Chi. 26/80
Yog. R. H. N. Shloka 9

Krimija ( Parasite) symptoms include pain like pricking needles, tearing pain, severe pain, itching, darkness before the eyes, nausea, wasting, scissoring pain in the Heart, anorexia, edema fever, syncope, dyspnoea.
Pathogenesis Vitiated Doshas like Vata etc. they vitiate Rasa Dhatu- Plasma and Heart. If the Heart has become already weak due to excessive stress and strain or other causes then the pathogenesis start – taking place at this site.