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SYMPTOM OF GHABRAHAT (CHEST APPREHENSION) IN INDIAN POPULATION

O P Kapoor
Hon. Visiting Physician, Jaslok Hospital and Bombay Hospital, Mumbai, Ex. Hon. Prof. of Medicine, Grant Medical College and JJ Hospital, Mumbai 400 008.

The text book of medicine brought out by API [1] does not discuss or even mention this word. Yet we hear of this symptom daily in private practice.

The cardiology pandits laugh off by saying that it means a sense of apprehension experienced in the chest! If that is so, why is it, that female patients do not complain of this symptom in western countries? In fact even in our country, this symptom is more commonly complained of by females; and that too more by Maharashtrians, Gujaratis, Sindhis, Muslims and Punjabis. Maharashtrians use the word "Ghabarta Sarkha Waatte" - Gujaratis, use the word 'Ghabhraman' or "Munjaro". Sindhis use the word "Monj". Rest all, use the word "Ghabrahat".

Most of them clarify when asked, that it is not palpitations (which is translated as "Dharkan').

Then what is the meaning of this word, which is used in the dispensary and the medical clinics by hundreds of patients everyday all over the country?

Who, is going to answer this question? General practitioners of course! It is they who can start writing letters addressed to the editor, of BHJ about their views, if not full length articles on the subject!

My impression is that this complaint or the 'word' is used whenever there is a feeling of insecurity or fear in the mind of the patient regarding the organs in the chest, mainly the heart and may be the lung.

First of all, I have often found patients using this word for "nausea"! Why? The reason is nausea produces an uneasy sensation in the "chest" (and often not in the abdomen, though it is an abdominal complaint). It is associated with peculiar restlessness which cannot be expressed properly. The second reason why nausea is mentioned as "Ghabrahat" is because in many Indian languages there is no word for nausea. Muslims use the word "Math" and Gujaratis use the word "Ubka". I have heard Christians from Goa using the word "dry vomit" for nausea. While in "Arab" language, there are distinct words for nausea and vomiting. These are "Loaa" and "Zoad' respectively. [2] (Incidentally Arab women almost never complain of anything like "Ghabrahat"!!)

Most practitioners will agree whole heartedly that this symptom is functional and calls for sympathetic hearing only. Sometimes it can be present as a superadded on an underlying organic disease of the heart. And if the patient has ischaemic heart disease, the doctor is not confident to pronounce this symptom as functional! It is worth remembering that 'Ghabrahat' is usually not a complaint seen in a "monosymptomatic" patient. It is always a "polysymptomatic" patient who complains of this symptom. Therefore, many other symptoms like giddiness, weakness etc. are also complained of by these patients.

The million dollar question is, can this symptom ever occur "due to" an organic heart disease? The answer to this question I am afraid, is "I do not know" - All I can say - that I have seen patients of "aortic valvular incompetence" who have dancing carotids in the neck and who complain of this symptom. When questioned directly, most of them "also" feel the palpitations of the heart in addition to "Ghabrahat". The former can be understood because of the haemodynamics of this disease.

Similarly during the attack of 'supra ventricular tachycardia' and in fact all tachyarrhythmias, I have seen patients who complain of 'Ghabrahat' in addition to fast palpitations! In all of them the excessive pulsations of the neck vessels were obvious. I do not know the significance of these findings.

I would like to narrate my experience with a VIP patient at Jaslok Hospital, few years ago is worth recording in this context. A Sindhi patient of chronic renal failure who was on long term haemodialysis, started developing cardiac complications due to hypertension. During three to four episodes, he was admitted to the intensive care unit and was discharged. According to the patient, he always preferred admission to ICU where he received better nursing and medical care, and monitoring, which he could afford.

In the terminal episode, he was admitted to ICU with the usual complaints and according to the doctors-in-charge, was doing well. One morning, I was summoned urgently by the patient, saying that he had 'severe ghabrahat' which is not being relieved by any medicines. I called the cardiologist, who confirmed that the patient's BP and heart were doing very well. He had no evidence of an infarct. In fact, his continuous cardiac monitoring which was going on in the ICU had not revealed any arrhythmias during the previous 8 to 12 hours when the patient was complaining of 'Ghabrahat'. I then called the nephrologist who confirmed that his blood biochemistry was OK and this symptom was due to fear!

After the nephrologist left, the patient called me and said "Doctor, everybody says I have nothing. But I am telling you that I am going to die. Do not leave me and go ~way!" I thought I would spend half an hour, which I had at my disposal and give him moral support. My eyes were on the cardiac monitoring and my hands on his Pulse. At the eighth minute, this patient had a cardiac arrest and could not he revived!!

Finally, it is worth noting that though patients of angina pectoris, myocardial infarction and bronchial asthma, only rarely complain of symptom of 'Ghabrahat', patients of COPD and status asthmaticus very often do!

ACKNOWLEDGEMENT

I am thankful to Dr. KS Varadhachary for having gone through the manuscript.

ACKNOWLEDGEMENT

I am thankful to Dr. KS Varadhachary for having gone through the manuscript.

REFERENCES

1. API Text Book of Medicine - Edited by Shantila) J Shih. Published by API. 1988; 396,

2. Kapoor OP. Common Chronic Disease Pattern~ Arabiar Gulf, Saudi Arabia and Yemen, SS Publishers. Mumbaii. 1983; 53.



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