79 year old with diabetes, hypertension, Ishaemic heart disease with no stents, valvular heart disease MR and previous history of breast cancer 3yrs ago. Her CMV IgG is unrecordably high with some EBV as well. She had 1 episode of angina few months ago (May 2021) which warranted hospitalization, but the cardiologist did not find any stenosed vessel. Hence with a negative angiogram he attributed the angina to hypertension. This subsequently subsided after I started her on low dose antiviral combo and the CMV, Epstein barr nosodes.

In July 2021 she completed her 2nd dose of Sinovac vaccine and within a month her insomnia was back, with anxiety, depression and mood swings. I couldn’t add sepia as her systolic BP was high but it was also labile managed with a calcium channel blocker and beta blocker. She has been on CMV nosode for 4 months now on and off but wasn’t consistent with the low dose antiviral combo.

This evening she came in with left sided chest pain radiating to back of scapula, BP was 160/60, pulse 90, SpO2 96 and very anxious. She was having sleepless night like never before .

Gave her homeopathy Lycopodium 200C 4 drops, Naja 30c 4 drops and amyl nitricum 200c 4 drops and external oxygen at 2 litres.

In about 20 minutes BP came down to 150/70, pulse 90 and oxygen didn’t budge. ECG showed ST elevations in all the inferior leads like the last episode.

So I gave Naja 200c 4 drops, anti IL 1 10 drops, dnase 10 drops and antivirals 20 drops. Repeated BP in 30 min. Patient was calm, BP at 130/70, pulse 84 and SpO2 100.

Patient refused hospital admission as there was no more chest pain. Wrote a referral just in case but she was doing fine at home.

I reckon the CMV reactivation post vaccine had a role to play in the angina, insomnia and mood swings thus far.