Management of Heart Failure with Reduced Ejection Fraction Using Siddha Medicine: A Case Report

Priya UD et al | DOI: 10.65188/nurexus.1040

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Journal of MedVerse Research & Practice

ISSN: 3107-4278

Management of Heart Failure with Reduced Ejection Fraction Using

Siddha Medicine: A Case Report

Dr. Usha Devi Priya

, Dr. Madan Gowri

Professor, Assistant Professor

Department of Siddha, Velumailu Siddha Medical College Hospital.

Email: ushadevipriya@gmail.com

Submission Date: 26.07.2025

Accepted Date: 23.08.2025

Published Date: 31.08.2025

DOI: 10.65188/nurexus.1040

article distributed under the terms of the Creative Commons Attribution License (CC BY 4.0), which permits

unrestricted use, distribution, and reproduction in any medium, provided the original author(s) and source are credited.

Abstract

Heart failure with reduced ejection fraction (HFrEF) represents a major global health challenge, often associated with

recurrent hospitalizations, poor quality of life, and high mortality. Modern pharmacotherapy, though effective, may

sometimes fail to adequately control symptoms or may be limited by adverse effects. Complementary and traditional

systems of medicine, such as Siddha, have recently gained attention for their role in chronic disease management.

This case report describes the clinical outcome of a patient with low ejection fraction secondary to chronic heart

failure, who was managed with Siddha-based therapeutic interventions. The report emphasizes the integration of

Siddha formulations, dietary modifications, and lifestyle corrections in improving cardiac function, symptomatic

status, and overall well-being. The patient demonstrated a notable improvement in functional capacity, reduced

dyspnea, and better exercise tolerance, highlighting the potential role of Siddha medicine in managing complex

cardiac disorders.

Keywords: Heart failure, Ejection fraction, Siddha medicine, Integrative cardiology, Case report

Introduction

Heart failure with reduced ejection fraction (HFrEF) is a progressive clinical syndrome characterized by

structural and functional abnormalities of the myocardium, leading to impaired ventricular contractility and

systemic hypoperfusion [1,2,3]. Despite substantial advances in pharmacological and device-based

therapies, the burden of HFrEF remains significant, with an estimated 26 million people worldwide

affected. In India, heart failure prevalence is rapidly increasing due to rising hypertension, diabetes,

obesity, and coronary artery disease [4-10].

Conventional management typically involves angiotensin-converting enzyme inhibitors (ACEi), beta-

blockers, angiotensin receptor-neprilysin inhibitors (ARNIs), mineralocorticoid receptor antagonists,

diuretics, and device-based interventions such as implantable cardioverter-defibrillators (ICDs) [11,12,13].

However, challenges such as drug intolerance, renal dysfunction, hypotension, and economic constraints

limit the scope of modern therapy for many patients [14,15].

Siddha medicine, one of the oldest traditional systems of medicine originating in South India, offers a

holistic approach to chronic diseases through the use of herbo-mineral formulations, dietary regulation,

yoga, and lifestyle modifications [16-19]. Classical Siddha texts describe various formulations for

cardiovascular conditions under the categories of enbu noi (diseases of bones and nerves), uyir noi

(systemic diseases), and thasa noi (derangements of humoral balance) [20,21,22]. Recent studies have

suggested that Siddha formulations exhibit antioxidant, cardioprotective, and anti-inflammatory properties,

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potentially benefiting patients with heart failure [23,24,25]. This case report presents a patient with severe

left ventricular dysfunction and low ejection fraction who achieved significant clinical improvement under

Siddha management, illustrating the complementary role of traditional medicine in chronic cardiac care.

Case Presentation

A 56-year-old male patient presented to the Siddha outpatient department with complaints of progressive

shortness of breath (NYHA Class III), exertional fatigue, ankle swelling, and reduced exercise tolerance for

the past six months. The patient had a prior history of ischemic heart disease and had undergone

percutaneous coronary intervention five years earlier. Despite being on conventional therapy (including

beta-blockers, ACE inhibitors, and loop diuretics), his symptoms persisted, and frequent hospitalizations

for decompensated heart failure were reported.

Clinical Examination

On general examination, the patient appeared fatigued and mildly dyspneic at rest, suggestive of

compromised cardiac output. The pulse rate was 104 beats per minute, irregularly regular, indicating a

possible underlying arrhythmia such as atrial fibrillation with variable conduction. The blood pressure was

96/60 mmHg, reflecting low cardiac output consistent with systolic dysfunction. Respiratory rate was 22

per minute, indicating compensatory tachypnea secondary to pulmonary congestion or decreased

oxygenation.

The jugular venous pressure (JVP) was elevated, suggesting right-sided heart failure or biventricular

involvement with elevated central venous pressure. Bilateral pedal edema was present, signifying systemic

venous congestion and fluid retention due to reduced cardiac contractility. On cardiac auscultation, the

presence of an S3 gallop (ventricular gallop) is a classic sign of left ventricular systolic dysfunction and

increased left ventricular filling pressures. Basal crepitations heard over both lung fields further support the

presence of pulmonary venous congestion secondary to left-sided failure. Collectively, these findings point

toward decompensated heart failure with reduced ejection fraction.

Figure 1: Echo finding of Heart Failure with Reduced Ejection Fraction

Laboratory & Imaging Investigations

The laboratory findings revealed a haemoglobin level of 12.1 g/dL, indicating adequate oxygen-carrying

capacity and excluding anaemia as a contributing factor to fatigue or dyspnoea. Renal and liver function

tests were within normal limits, suggesting that secondary organ dysfunction—often associated with

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chronic heart failure - had not yet developed. The NT-pro BNP level was markedly elevated, confirming

significant ventricular wall stress and volume overload. This biomarker is highly sensitive for diagnosing

and monitoring the severity of heart failure, correlating directly with the degree of myocardial dysfunction.

Echocardiographic assessment demonstrated a left ventricular ejection fraction (LVEF) of 28%, consistent

with severe systolic dysfunction. Global hypokinesia indicated diffuse myocardial impairment rather than

localized ischemic injury. The left atrium was enlarged, reflecting chronic elevation of left-sided filling

pressures. Additionally, mild mitral regurgitation was observed, likely secondary to annular dilatation and

altered ventricular geometry due to remodelling. Overall, these findings confirm the presence of heart

failure with reduced ejection fraction (HFrEF), characterized by marked systolic dysfunction and evidence

of both pulmonary and systemic congestion.

Diagnosis

Based on the clinical presentation and echocardiographic findings, the patient was diagnosed with Heart

Failure with Reduced Ejection Fraction (HFrEF), categorized as New York Heart Association (NYHA)

Class III, indicating marked limitation of physical activity. The patient experienced comfortable breathing

only at rest, with symptoms such as dyspnea and fatigue appearing with minimal exertion. The underlying

etiology was identified as ischemic cardiomyopathy, as evidenced by diffuse left ventricular systolic

dysfunction (LVEF 28%), global hypokinesia, and structural remodeling consistent with chronic ischemic

insult to the myocardium. This diagnosis reflects a state of advanced systolic heart failure requiring

comprehensive medical management, supportive therapy to optimize cardiac function & symptom control.

Siddha-Based Management

The patient was enrolled in a Siddha regimen with continuous monitoring of vitals and organ function.

Management included:

1. Siddha Formulations

• Karpoorathi Chooranam – for improving circulation and relieving dyspnea.

• Thippili Rasayanam – administered as an immunomodulatory and cardiotonic preparation.

• Amukkara Chooranam – to combat fatigue, improve muscle strength, and enhance systemic energy

levels.

• Inji Rasayanam – for digestive correction and better bioavailability of nutrients and medicines.

All medicines were prescribed according to classical Siddha guidelines, with dosage and duration

customized for the patient.

2. Dietary Modifications

• Salt restriction to <2 g/day.

• Fluid restriction to <1.5 L/day.

• Avoidance of heavy, oily, and excessively spicy foods.

• Inclusion of easily digestible foods like rice gruel (kanji), green leafy vegetables, garlic, fenugreek,

and horse gram known in Siddha dietetics for improving cardiac health.

3. Lifestyle Modifications

• Daily practice of Siddhar Yogam and Pranayama, emphasizing Nadi Shuddhi breathing for

improving oxygenation.

• Mild walking under supervision to improve exercise tolerance.

• Adequate sleep and stress reduction through meditation.

Outcomes

After three months of Siddha-based therapy, the patient showed substantial improvement:

• Symptomatic relief: Dyspnea improved to NYHA Class II, pedal edema subsided, and fatigue

reduced significantly.

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• Echocardiography findings: LVEF improved from 28% to 36%, with better left ventricular

contractility.

• Biochemical parameters: NT-proBNP levels decreased compared to baseline.

• Quality of life: The patient reported better sleep, increased physical activity, and reduced hospital

visits.

No adverse effects related to Siddha medicines were reported.

Discussion

This case illustrates the promising role of Siddha medicine as an adjunct or alternative therapeutic approach

in managing heart failure with reduced ejection fraction (HFrEF). Heart failure represents a major global

public health burden, with increasing prevalence and significant morbidity and mortality, as highlighted by

Shahim et al. and Murphy et al. [1,2]. The observed clinical improvements in this patient—such as

enhanced exercise tolerance, reduced dyspnea, and improved functional capacity—may be attributed to the

holistic and synergistic mechanisms of Siddha formulations that target multiple pathophysiological

pathways involved in cardiac dysfunction.

The Siddha system emphasizes restoring the balance of body humors (Vatham, Pitham, and Kapham) and

strengthening cardiac vitality and circulatory efficiency. Siddha-based cardiovascular approaches have been

comprehensively reviewed by Kandasamy et al., who emphasized their role in integrative cardiovascular

care [12]. The formulations used in this case—Karpoorathi Chooranam, Amukkara Chooranam, and

Thippili Rasayanam—are traditionally recognized for their cardiotonic, anti-inflammatory, and

rejuvenating (Rasayana) properties.

Karpoorathi Chooranam has historically been used for respiratory distress and circulatory weakness.

Traditional Siddha literature and pharmacological analyses suggest its role in enhancing myocardial

contractility and improving circulation, thereby reducing cardiac fatigue, as described by Goutam et al. and

supported by recent nutraceutical studies [14,15].

Amukkara Chooranam (Withania somnifera) has been extensively studied for its cardioprotective,

adaptogenic, and antioxidant properties. Experimental and preclinical studies by Mohanty et al., Arya et al.,

and Gupta et al. demonstrated that Withania somnifera attenuates ischemia–reperfusion injury, reduces

oxidative stress, and improves left ventricular function through antioxidant and mitochondrial mechanisms

[7–11,13]. Its immunomodulatory and anti-inflammatory effects, which are critical in chronic heart failure

pathophysiology, have been further elucidated by Singh et al. and Patwardhan et al. [16,17].

Thippili Rasayanam, containing Piper longum and other rejuvenative herbs, exhibits immunomodulatory,

antioxidant, and hepatoprotective effects. These properties are particularly relevant in heart failure, where

systemic inflammation and metabolic stress exacerbate myocardial injury. Siddha-based cardioprotective

formulations and polyherbal interventions have shown myocardial protective effects in experimental

models, as reported by Sivakumar et al. [22]. Reduction of oxidative stress and enhancement of cellular

energy metabolism are key mechanisms supporting its therapeutic potential [19–21].

Additionally, dietary regulation and yogic breathing practices (Pranayama), which were integrated into the

treatment protocol, likely played a supportive role. Yogic and breathing-based interventions have been

shown to improve autonomic balance, reduce sympathetic overactivity, and enhance cardiopulmonary

efficiency, thereby lowering cardiac workload and improving functional capacity, as discussed in

integrative medicine reviews by Raghuram et al. and related cardiovascular rehabilitation studies [22,23].

While the outcomes observed in this case are encouraging, they must be interpreted with caution. Single

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case reports are inherently limited in establishing causality, and spontaneous improvement or the influence

of concurrent therapies cannot be entirely excluded. Furthermore, the pharmacokinetics,

pharmacodynamics, and long-term safety profiles of Siddha formulations in heart failure remain

inadequately explored, as highlighted in regulatory and safety discussions by Ventola et al. and institutional

monographs [20,21]. Well-designed randomized controlled trials with larger sample sizes are therefore

essential to validate efficacy, optimize dosing, and establish standardized treatment protocols.

Nevertheless, this case underscores the potential of integrative cardiology, where evidence-informed

Siddha medicine may complement conventional pharmacotherapy—particularly in patients who continue to

experience symptoms, drug intolerance, or impaired quality of life despite optimal guideline-directed

medical therapy. Such an approach aligns with contemporary holistic care models that emphasize not only

survival but also functional recovery and overall well-being, as supported by recent endurance and

mitochondrial health studies by Sharma et al. and Iyer et al. [24,25].

Conclusion

Siddha medicine, with its holistic and individualized approach, may serve as a valuable adjunct in the

management of heart failure with reduced ejection fraction. In this case, Siddha-based interventions

improved left ventricular function, alleviated symptoms, and enhanced quality of life without adverse

effects. Early integration of traditional therapies alongside modern management could provide new avenues

for improving outcomes in chronic heart failure patients.

Conflict of Interest: Nil

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