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

Priya, Usha Devi; Gowri, Madan

doi:10.65188/nurexus.1040

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CASE REPORT

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

1

, Dr. Madan Gowri

2

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

access 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. 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) [4-9]. However, challenges such as drug

intolerance, renal dysfunction, hypotension, and economic constraints limit the scope of modern therapy

for many patients. 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 [10-13]. 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).

Recent studies have suggested that Siddha formulations exhibit antioxidant, cardioprotective, and anti-

inflammatory properties, potentially benefiting patients with heart failure [14-18]. 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

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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

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

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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

The patient was enrolled in a Siddha treatment regimen with continuous monitoring of vital signs and

organ function. Karpoorathi Chooranam was administered to improve circulation and relieve dyspnoea,

while Thippili Rasayanam was prescribed for its proposed immunomodulatory and cardiotonic effects.

Amukkara Chooranam was used to address fatigue, improve muscle strength, and enhance energy

levels. Inji Rasayanam was administered to support digestion and improve the bioavailability of

nutrients and medicines. All formulations were prescribed according to classical Siddha guidelines, with

dosage and duration individualized according to the patient's condition.

2. Dietary Modifications

Dietary modifications included salt restriction to less than 2 g/day and fluid restriction to less than 1.5

L/day. Heavy, oily, and excessively spicy foods were avoided. Easily digestible foods, including rice

gruel (kanji), green leafy vegetables, garlic, fenugreek, and horse gram, were incorporated into the diet

in accordance with Siddha dietary practices intended to support cardiac health.

3. Lifestyle Modifications

Lifestyle modifications included daily practice of Siddhar Yogam and pranayama, particularly Nadi

Shuddhi breathing, with the aim of supporting respiratory function and relaxation. Mild walking was

encouraged under supervision to improve exercise tolerance. Adequate sleep and stress management

through meditation were also recommended as components of the overall management plan.

Outcomes

After three months of Siddha-based therapy, the patient demonstrated substantial clinical improvement.

Dyspnoea improved to New York Heart Association (NYHA) functional class II, pedal oedema

subsided, and fatigue was significantly reduced. Echocardiographic assessment revealed an

improvement in left ventricular ejection fraction (LVEF) from 28% to 36%, indicating improved left

ventricular contractility. NT-proBNP levels also decreased compared with baseline values. The patient

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reported improved sleep quality, increased physical activity, and fewer hospital visits, suggesting an

improvement in overall quality of life. No adverse effects associated with the Siddha medicines were

reported during the treatment period.

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

[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, emphasizing 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 in previous

studies 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 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 in previous studies [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 [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 and related cardiovascular rehabilitation studies [22].

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

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

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

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

inadequately explored, as highlighted in regulatory and safety discussions 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 [21].

Summary

This case report describes a 56-year-old man with ischemic cardiomyopathy and heart failure with

reduced ejection fraction (HFrEF), presenting with dyspnoea, fatigue, and pedal oedema despite

conventional treatment. Echocardiography revealed severe left ventricular systolic dysfunction, with an

ejection fraction of 28%. Following three months of Siddha-based therapy, dietary modifications, and

lifestyle interventions, the patient showed symptomatic improvement, with NYHA functional class

improving from III to II and LVEF increasing to 36%. NT-proBNP levels decreased, and no adverse

effects were reported. These findings suggest potential benefits of an integrative management approach;

however, further controlled studies are required to establish the efficacy and safety of Siddha therapy as

an adjunct to standard heart failure treatment.

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.

Declaration

Source of funding: Nil

Conflict of Interest: Nil

Ethics: Written informed consent was obtained from the patient for publication of the clinical details and

relevant images, ensuring confidentiality and anonymity.

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