Homoeopathic Cardiac Drugs: Sphere of Action, Pathophysiology, PQRS Symptoms & Indications

Understanding PQRS in Homoeopathic Context

• P - Peculiar/strange/rare/uncommon symptoms (never seen in ordinary disease)
• Q - Qualifying symptoms (unique sensations, characters)
• R - Rare & uncommon concomitants
• S - Singular/striking symptoms

Classification of Main Cardiac Remedies by Layer/Condition

1. DIGITALIS PURPUREA (Foxglove)

Source

Sphere of Action / Pathophysiology

PQRS Symptoms

• P (Peculiar): "Heart feels as though it would STOP BEATING if she moved" - the patient lies absolutely still from fear of this sensation
• P: Pulse slow when lying down, but irregular and dicrotic on sitting up
• Q: "Sensation as if heart stood still" - one of the most characteristic sensations in the materia medica
• R: Pale, earthy face with intense anxiety; jaundice with cardiac failure (hepatic congestion from right heart failure)
• S: Intermittent pulse - every 3rd, 5th or 7th beat drops out (irregular intermission)

Keynote Indications (Boericke/Allen)

• Slow, weak, irregular pulse - the key guiding feature
• Heart failure with extreme bradycardia (pulse as slow as 40-50/min)
• Auricular flutter and fibrillation with slow ventricular rate
• Dropsy (anasarca) from cardiac origin with scanty urine
• Palpitation on going up even a slight ascent or from least motion
• Cyanosis; cold, blue extremities
• Great weakness; faintness with any exertion

Modalities

• Worse: Motion, sitting up, any exertion, cold
• Better: Lying still, empty stomach

Potency (Boericke): 3x - 30c

2. CACTUS GRANDIFLORUS (Night-blooming Cereus)

Source

Sphere of Action / Pathophysiology

PQRS Symptoms

• P (Peculiar): Sensation as if the heart were clasped and unclasped rapidly by an iron hand - the signature symptom; constrictive pain as if bound with an iron band
• P: Whole chest feels caged, each wire being tightened - a constriction that no other remedy replicates
• Q: Heart feels as if it would be squeezed flat; squeezing sensation in apex
• R: Hemorrhages (passive, dark blood) - hemoptysis, hematuria associated with cardiac conditions
• S: Constriction extends to throat and down the arm; feels like it would stop breathing

Keynote Indications (Boericke/Allen)

• Angina pectoris with violent, constricting precordial pain radiating to left arm, with great anxiety and fear of death
• Feeble, irregular, intermittent pulse with violent palpitation
• Oppression of chest; dyspnea - cannot lie on left side (also Spigelia)
• Tobacco heart - cardiac disorder from tobacco abuse
• Endocarditis with mitral insufficiency
• Constriction at base of heart; edema of feet and ankles
• Waking at night with choking, suffocating, smothering sensation

Modalities

• Worse: Around 11 AM, lying on left side, walking, going upstairs
• Better: Open air, lying on right side with head raised

Potency: 3x - 30c; tincture for functional use

3. SPIGELIA ANTHELMIA (Pink Root)

Source

Sphere of Action / Pathophysiology

PQRS Symptoms

• P (Peculiar): Violent, visible, audible palpitation - you can see the heart beating through the clothing and feel it pulsating all over the chest
• P: "Heart feels too large for the chest" - bulging sensation
• Q: Stitching, stabbing pains at and around the heart, synchronous with each heartbeat
• R: Extreme sensitivity to touch and jar - jarring the bed or footsteps aggravate pain
• S: Pain radiates to left shoulder, arm, neck, and back of the head in a specific neuralgic pattern; pain at the left temple and left arm simultaneously

Keynote Indications (Boericke/Allen)

• Acute pericarditis with pericardial effusion; loud friction rub
• Endocarditis, myocarditis - great remedy for all layers
• Angina pectoris with intense precordial pain
• Violent, irregular palpitation; can hear and see the heartbeat
• Dyspnea with every change of position; must lie on right side with head raised
• Rheumatic carditis following joint pains
• Neuralgia of the heart; left-sided neuralgic pain

Modalities

• Worse: Touch, jar, motion, cold, wet, turning eyes, any concussion
• Better: Lying on right side with head raised (characteristic modality)

Potency: 6c - 200c; lower (2-3c) for inflammatory symptoms; 6c-30c for neuralgic symptoms

4. NAJA TRIPUDIANS (Cobra Venom)

Source

Sphere of Action / Pathophysiology

PQRS Symptoms

• P (Peculiar): Sensation of weight and heaviness dragging on the heart - as if heart is being pulled down
• P: Cannot speak - sudden loss of voice with cardiac distress (inability to speak with choking = keynote per Clarke)
• Q: "Heart felt drawn in toward the right side" (and toward the ovary in women)
• R: Pulse - slow and irregular in force but regular in rhythm; sometimes suddenly rapid (120/min) and full
• S: Pains about the heart extending to nape of neck, left shoulder and arm with intense anxiety and fear of death; sweating palms as concomitant (Kent's cured case)

Keynote Indications (Boericke/Clarke/Allen)

• Acute and chronic septic endocarditis; valvular disease after diphtheria, typhoid, or other infectious fevers
• Heart affections after grief or emotional shock ("dragging anxiety in the praecordia in great grief" - Clarke)
• Organic heart disease: valvular insufficiency, especially mitral
• Stitching pains at cardiac region, worse on inspiration
• Marked depression and prostration with cardiac disease
• Post-fever cardiac sequelae (septic myocarditis)
• Pulse slow, feeble, thready, scarcely perceptible

Modalities

• Worse: Night, walking, lying on left side
• Better: Lying on right side

Potency: 30c - 200c; use higher for constitutional and emotional cases

5. CRATAEGUS OXYACANTHA (Hawthorn)

Source

Sphere of Action / Pathophysiology

PQRS Symptoms

• P (Peculiar): Extreme weakness of the heart out of proportion to other symptoms - the patient feels the heart is giving out but may look fairly well
• P: Apprehension and extreme anxiety with sudden loss of strength in all muscles simultaneously
• Q: "Heart collapses, seems too tired to beat"
• R: Numbness of left arm and hand with cardiac weakness - the arterial supply is particularly affected
• S: Dyspnea on the least exertion; walks slowly to avoid breathlessness

Keynote Indications (Boericke/Duncan)

• Fatty and failing heart - one of the primary remedies
• Arteriosclerosis with cardiac weakness; high blood pressure with cardiac complications
• Angina pectoris - especially in elderly patients with weak myocardium
• Mitral stenosis and regurgitation with very feeble action
• Cardiac dropsy with extreme weakness
• Pulse: very feeble, irregular, intermittent (especially every 3rd beat)
• Extreme dyspnea with any motion; cardiac asthma
• Safe for long-term use as a cardiac supportive remedy

Modalities

• Worse: Exertion, warm room, ascending stairs
• Better: Rest, quiet, open air

Potency: Tincture (Q) to 3x widely used; also 6c - 30c; can be used as a supportive alongside constitutional treatment

6. AURUM METALLICUM (Gold)

Source

Sphere of Action / Pathophysiology

PQRS Symptoms

• P (Peculiar): Cardiac asthma from profound grief or loss - the heart reflects the unbearable emotional burden directly; can weep but finds no relief
• P: Violent palpitation with tremulous fearfulness and anxiety - literally trembles with every heartbeat
• Q: The heart feels as if it has too much blood - fullness and congestion, "too full," pulsation all over the body
• R: Worse ascending stairs - the cardiac symptoms are directly tied to any upward exertion (like climbing stairs, walking uphill)
• S: Suicidal ideation with the cardiac and mental state - unique concomitant; despair combined with palpitations and anxiety

Keynote Indications (Boericke/Kent)

• Hypertensive heart disease with marked emotional etiology (grief, loss of honour, position)
• Cardiac hypertrophy - particularly right-sided hypertrophy with organic disease
• Arteriosclerosis, aortitis with high blood pressure
• Angina pectoris with extreme anxiety and sense of impending doom
• Endocarditis, valvular disease in syphilitic constitution
• Violent palpitation at night; pulsating arteries throughout the body at night
• Cardiac asthma with orthopnea
• Pericarditis in gonorrheal or syphilitic patients

Modalities

• Worse: Night, cold, mental exertion, ascending stairs, emotional stress
• Better: Walking (as opposed to ascending), warmth

Potency: 30c - 1M; high potencies for constitutional work

7. KALMIA LATIFOLIA (Mountain Laurel)

Source

Sphere of Action / Pathophysiology

PQRS Symptoms

• P (Peculiar): Rheumatic pain travels downward - from heart/chest down to the legs; opposite of Spigelia where pain travels up to the head
• P: Pulse slow, irregular, weak - a prominent slowing effect on the pulse in organic disease
• Q: "Stitching pain in cardiac region with violent rapid palpitation" in alternate attacks
• R: Numbness and tingling of the left arm and hand as a concomitant
• S: Cardiac affection after rheumatic fever or after gonorrhea (suppression) - the timing is the PQRS keynote

Keynote Indications (Boericke/Allen)

• Valvular disease of the heart - especially after acute rheumatic fever
• Endocarditis, pericarditis following rheumatism
• Hypertrophy with regurgitation; mitral and aortic valve disease
• Angina pectoris with slow pulse and pain down left arm
• Palpitation: visible, violent; wakes from sleep
• Dyspnea and oppression with every change of weather
• Rheumatic patients with cardiac complications - rheumatism ascends while cardiac symptoms worsen

Modalities

• Worse: Leaning forward, motion, cold, turning over in bed
• Better: Lying on right side (like Spigelia and Naja)

Potency: 3c - 200c

8. SPONGIA TOSTA (Roasted Sponge)

Source

Sphere of Action / Pathophysiology

PQRS Symptoms

• P (Peculiar): Waking from sleep in panic with violent palpitation and suffocation - "starts from sleep" as if it will die; must sit upright with head thrown back
• P: Loud, barking, hollow croupy cough as a cardiac concomitant (cardiac cough in valvular disease)
• Q: Anxiety, palpitation, and dyspnea relieved by eating and drinking - very peculiar amelioration
• R: Sawing or wheezing respiration with cardiac symptoms; great nervous fear of death with fluttering heart
• S: Every cardiac symptom is associated with an extraordinary fear - fear of death, restlessness, anxiety out of proportion

Keynote Indications (Boericke/Allen)

• Valvular heart disease (aortic insufficiency especially) with marked dyspnea
• Hypertrophy of the heart with obstructed respiration
• Goitre heart - cardiac disorder in patients with thyroid enlargement
• Angina pectoris: suffocative, wakes from sleep gasping
• Palpitation in thyrotoxic patients; palpitation with exophthalmos
• Constriction in cardiac region; heaviness over heart
• Pulse: rapid, full, hard; or irregular with dropsy

Modalities

• Worse: Lying down, touch, cold air, exertion, before midnight
• Better: Sitting upright with head back, warm food and drink, eating (unique cardiac modality)

Potency: 3c - 30c

9. ARSENICUM ALBUM (Arsenic trioxide)

Source

Sphere of Action / Pathophysiology

PQRS Symptoms

• P (Peculiar): Anxiety proportional to disease severity - the sicker the patient, the more intense the restless anxiety; this distinctive anguish is the cardiac keynote
• P: Restlessness with extreme prostration - wants to move but is too weak; must change position constantly
• Q: Fear of death combined with feeble, rapid, irregular pulse
• R: Burning pains relieved by heat (paradoxical - all inflammatory symptoms better heat)
• S: Midnight to 2 AM aggravation - cardiac anxiety, palpitation, and dyspnea specifically worse at 1-2 AM

Keynote Indications (Boericke/Kent)

• Cardiac failure with marked anxiety, restlessness, and fear of death
• Arteriosclerosis with cardiac symptoms; angina pectoris
• Palpitation violent, rapid pulse; cold sweat
• Pericarditis with effusion; endocarditis
• Mitral insufficiency with edema
• Cardiac dyspnea worse 1-2 AM
• Arsenicum in terminal heart failure

Modalities

• Worse: 1-2 AM, cold, cold drinks, exertion
• Better: Heat (in general), warm applications, sitting upright

10. GLONINUM (Nitroglycerin)

Source

Sphere of Action / Pathophysiology

PQRS Symptoms

• P (Peculiar): "Laborious action and pressure as if the heart is being contracted or squeezed" combined with explosive, throbbing headache - a simultaneous cardiac and cerebral event
• P: Cannot bear sun on the head - direct aggravation from sun exposure triggering cardiac-cerebral events
• Q: Violent throbbing carotids visible and palpable with each heartbeat; the whole body pulsates
• R: Forgets where he is - confusion and disorientation with cardiac crisis
• S: Cardiac pain from excitement, heat of sun, or suppressed menses

Keynote Indications (Boericke)

• Angina pectoris with cerebral congestion
• Acute hypertensive crisis - sudden violent pulsation
• Precordial pain with violent palpitation
• Sun stroke with cardiac involvement
• Cardiac oppression with feeling of head expansion
• Worse stooping, bending down; pulsation felt all over

Modalities

• Worse: Heat of sun, jar, bending head forward, wine, exertion
• Better: Open air, cold applications

11. LACHESIS (Bushmaster Venom)

Source

Sphere of Action / Pathophysiology

PQRS Symptoms

• P (Peculiar): Cannot tolerate anything tight around the neck or chest - collar, necklace, or binding clothing immediately aggravates cardiac symptoms; must loosen all clothing
• P: Worse after sleep - wakes from sleep in cardiac distress; all symptoms worse on waking or after sleep
• Q: Palpitation with sensation as if something is moving around the heart
• R: Left-sided predominance - all symptoms predominantly left-sided; left chest to left arm
• S: Cardiac symptoms with jealousy, suspicion, or loquacity as mental concomitant

Keynote Indications (Boericke/Kent)

• Valvular disease - mitral valve most affected; cardiac hypertrophy
• Palpitation in menopausal women with hot flushes
• Angina pectoris: suffocating, cannot bear constriction
• Cyanosis with cardiac disease
• Endocarditis in a septic or erysipelatous state
• Palpitation with trembling; worse left side

Modalities

• Worse: Sleep, tight clothing, touch on throat, heat, left side
• Better: Onset of discharge (menses, suppuration), open air, right side

12. STROPHANTHUS HISPIDUS

Source

Sphere of Action / Pathophysiology

PQRS Symptoms

• P: Cardiac weakness in the elderly with arteriosclerosis - the constitutional picture is old age and cardiac degeneration
• Q: Tachycardia with great nervousness and exhaustion
• R: Dropsy (edema) of cardiac origin in aged patients particularly useful when Digitalis fails
• S: Diabetes with cardiac disease - the combination of glycosuria and heart failure pointing to Strophanthus

Keynote Indications (Boericke)

• Weak, rapid pulse with cardiac exhaustion in elderly
• Cardiac dropsy and fluid retention
• Tachycardia; nervous palpitation
• Fatty heart in the aged
• An intercurrent cardiac tonic when other remedies have partially acted

Potency: Tincture (Q) to 3x

13. ADONIS VERNALIS (Pheasant's Eye)

Source

Sphere of Action / Pathophysiology

PQRS Symptoms

• P: Cardiac weakness after influenza or febrile illness - post-viral myocarditis picture
• Q: Rapid, irregular, and feeble pulse with respiratory distress
• R: Urinary output increases as cardiac function improves - a functional measure of its action
• S: Cardiac symptoms with scanty urine (oliguria from cardiac failure) as a concomitant

Keynote Indications

• Mitral regurgitation with failing compensation
• Post-febrile cardiac weakness
• Arteriosclerosis with cardiac failure
• Fatty degeneration of the heart
• Urinary oliguria from cardiac causes

Potency: 3x - 30c

14. CONVALLARIA MAJALIS (Lily of the Valley)

Source

Sphere of Action / Pathophysiology

PQRS Symptoms

• P (Peculiar): Right-sided cardiac hypertrophy with attacks of palpitation and angina - exclusively right-sided cardiac keynote (as opposed to Spigelia and Naja which are left-sided)
• Q: "Feeble, irregular contraction with venous stasis in extremities" after the cardiac attacks
• R: Severe headache on the right side concurrent with cardiac attacks
• S: Cardiac attacks precipitated by over-exertion specifically

Keynote Indications (Boericke/Duncan)

• Right-sided hypertrophy of the heart
• Venous stasis, passive congestion
• Endocarditis with pericarditis (acts on both)
• Tobacco heart; palpitation from tobacco
• Anasarca from cardiac failure

15. LATRODECTUS MACTANS (Black Widow Spider)

Source

Sphere of Action / Pathophysiology

PQRS Symptoms

• P (Peculiar): "Precordial pain with radiation to the left shoulder and arm with tingling in left hand" and inability to move the arm - a classic anginal picture but with extreme violence
• Q: Cold, pulseless sweat with the attack; feels as if dying
• R: Screaming with the pain - the extremity of the pain drives the patient to cry out
• S: No pulse during the attack - pulselessness from cardiovascular collapse

Potency: 6c - 200c in acute attack

16. TABACUM (Tobacco)

Source

Sphere of Action / Pathophysiology

PQRS Symptoms

• P: Icy coldness over the entire body with palpitation - unlike other cardiac remedies where there is heat or fever
• P: Sudden, overwhelming nausea with palpitation; deathly sick feeling
• Q: Pulse intermittent and irregular with great debility
• R: Palpitation worse from opening the eyes
• S: Uncovering the abdomen brings great relief (a uniquely peculiar modality)

Keynote Indications

• Tobacco heart - cardiac neurosis from tobacco abuse
• Angina from smoking; nicotine carditis
• Palpitation in anemic, nervous patients

Comparative PQRS Table - Quick Reference

Notes on Prescribing Principles (Kent / Boericke)

1. Acute vs. Chronic prescribing: In acute cardiac emergencies (acute angina, arrhythmia), use low-to-mid potencies (3x-30c) frequently. In chronic valvular or structural disease, use higher potencies (200c-1M) less frequently with the constitutional remedy.
2. PQRS hierarchy: Symptoms in order of importance - (1) Mind symptoms, (2) Strange/rare/peculiar physical symptoms, (3) Common general symptoms, (4) Local symptoms. The PQRS must be matched before prescribing.
3. Layer-based prescribing: Choose remedies based on which cardiac layer is primarily affected (pericardium → Spigelia, Colchicum; myocardium → Digitalis, Crataegus, Adonis; endocardium/valves → Naja, Kalmia, Spongia).
4. Constitutional + specific: Per Hahnemann (Organon §80-§82), true chronic heart disease requires constitutional treatment; specific cardiac remedies control acute manifestations.