The American Heart Association estimates that 4.7 million Americans have congestive heart failure (CHF) and that 400,000 new cases will be diagnosed in the coming year. Heart failure is the leading cause for hospitalization in people over the age of 65, and the risk for developing the disease increases with age. The risk for developing heart failure is slightly greater in men than in women. African-Americans are twice as likely to acquire the disease as Caucasians, and mortality from the disease is also twice as great in this group. Since the 1970s, heart failure has been on the increase because the number of people aged 65 or older has grown. Approximately 20% of CHF patients will die within 1 year of diagnosis, and 50% will die within 5 years.
Congestive heart failure occurs when the heart is unable to pump blood throughout the body (but not all patients with heart failure have congestion). There are two categories of congestive heart failure: systolic and diastolic. In the systolic type of the disease, blood coming into the heart from the lungs may be regurgitated so that fluid accumulates in the lungs (pulmonary congestion). In the diastolic type, the heart muscle becomes stiff and cannot relax, leading to an accumulation of fluid in the feet, ankles, legs, and abdomen.
Congestive heart failure is in itself not a diagnosis. Rather it is the physiological result of damage to the heart caused by some underlying condition. Therefore, it is not enough to say that a person has congestive heart failure. The CHF has to be due to some underlying process, and that diagnosis is important in terms of treatment and prognosis.
Cardiomyopathy is a condition in which the heart muscle is damaged and no longer functions properly. It is divided into three categories: dilated, hypertrophic, and restricted. Dilated cardiomyopathy, where the heart muscle becomes thin and stretched, may be caused for unknown reasons (idiopathic), by alcoholism, and by endocrine or genetic diseases. Restrictive cardiomyopathy results when some disease process restricts the movement of the heart. This may be caused by amyloidosis, prior heart surgery, and diabetes, for example. Hypertrophic cardiomyopathy, where the heart muscle becomes enlarged and thickened, is due to high blood pressure and failure of the heart's valves.Risk Factors for Congestive Heart Failure
The most common underlying cause for congestive heart failure is hypertension (high blood pressure). The Framingham Heart Study recently reported that high blood pressure increased the risk of developing heart failure about 2 times for men and 3 times for women. A second important risk factor for the disease is diabetes mellitus. The incidence of heart failure among diabetics is three to eight times greater than in the normal population. Other forms of cardiac disease, such as myocardial infarction, valve disease, rheumatic heart disease, and certain types of congenital conditions, also increase the potential for developing heart failure. Secondary risk factors include smoking, obesity, and high cholesterol.Signs and Symptoms
A number of generalized symptoms are associated with heart failure; they include fatigue, fluid accumulation (edema), and persistent coughing. The symptom most associated with the disease is dyspnea, or shortness of breath. In particular, the patient may develop orthopnea or cardiac asthma. This is the case when a patient needs several pillows to sleep on to prevent shortness of breath. Another way orthopnea manifests is that the patient may awaken short of breath and go stand up by a window to breathe better. The shortness of breath is positional, caused by positional changes in blood flow. Heart failure generally develops slowly, and the patient is often unaware of the condition until symptoms appear.Diagnosis of Congestive Heart Failure and Cardiomyopathy
In many cases, the diagnosis of congestive heart failure is made on physical examination. The patient may present with edema, shortness of breath, and fatigue and orthopnea as described above. Risk factors (e.g., hypertension, diabetes etc.) for the disease are evaluated during the examination. A relatively simple procedure for determining the presence of heart failure is the electrocardiogram (ECG). Echocardiograms, which evaluate heart function, may also be ordered by the physician. Chest x-rays can reveal the size and shape of the heart and rule out other causes of the patient's symptoms.Conventional Treatments for CHF
Although CHF can be treated and improved by therapy, it is important to treat the underlying cause to prevent progression and worsening of symptoms leading to death. The protocols dealing with specific problems such as high blood pressure or vascular disease should be consulted.
Various types of medications are used in the treatment of CHF, each of which has a different function. ACE (angiotensin-converting enzyme) inhibitors and vasodilators expand blood vessels, thereby allowing the heart to function more efficiently. Beta-blockers reduce oxygen demand in the left ventricle, which is often damaged in patients with CHF. Digitalis increases the pumping action of the heart, and diuretics eliminate fluid accumulation. In some cases, successful control of hypertension can eliminate CHF.
One new medication recently approved by the FDA, Carvedilol, was found to be of significant value to patients with mild to moderate CHF when used in conjunction with diuretics, ACE inhibitors, and digoxin. Clinical trials of this medication indicate that hospitalization time for CHF, as well as morbidity and mortality from the disease, was considerably reduced. In the most severe cases of CHF, cardiac transplant may be necessary. A study of conventional medications for the treatment of CHF reported the following percentages of use:
- Diuretics, 82%
- ACE inhibitors, 53%
- Nitrates, 49%
- Digoxin, 46%
- Potassium, 40%
- Aspirin, 36%
- Calcium antagonists, 20%
- Coumadin (Warfarin), 17%
- Beta-blockers, 15%
- Magnesium, 10%
Diuretics deplete the body of potassium and magnesium. Patients who are taking diuretics should consult with their physician regarding supplementation of these electrolytes.
In a clinical trial of 111 CHF patients, a left ventricular assist device (LVAD) was implanted in the patients while they awaited transplantation. Five patients implanted with the LVAD prior to transplant were successfully weaned from the device and were no longer in need of the transplant. More importantly, the study indicated that LVADs worked to modify cardiac function and could potentially benefit patients with cardiomyopathy as well. A surgical strategy for congestive heart failure, mitral valve repair, may offer another alternative to transplantation. In this procedure, the mitral valve is strengthened by surgically implanting a small, flexible ring at the valve opening, thereby preventing regurgitation. The results of the study indicated that the procedure could improve exercise tolerance and cardiac function, and decrease heart enlargement.Natural Treatments for Congestive Heart Failure
Coenzyme Q10 is a naturally occurring substance that may have considerable value as an adjunct therapy for the treatment of CHF. Clinical studies indicate that coenzyme Q10 can improve the quality of life, allow for a reduction of other pharmacological agents, and decrease the incidence of cardiac complications from CHF. In those patients who receive little benefit from conventional medications, coenzyme Q10 may be a highly effective form of therapy. One study evaluated the cardiac parameters of 17 CHF patients after a 4-month trial period of coenzyme Q10. The following results were reported:
- Heart function improved by 20%, and the mean CHF score increased significantly.
- Left ventricular ejection fraction (a measure of the heart's capacity to pump efficiently) improved nearly 35%.
- Cardiac output improved by 15.7%.
- Stroke volume index improved nearly 19%.
- Systolic blood pressure decreased by 4.4%.
- End-diastolic volume area decreased by 8.4%.
- Mean exercise duration improved by 25.4%.
- Cardiac workload improved by 14.3%.
The researchers concluded that coenzyme Q10 was associated with significant functional, clinical, and hemodynamic improvements and that the risk-to-benefit ratio was extremely favorable. Coenzyme Q10 exerted a positive influence on the muscular contractility of the myocardium while enhancing vasodilation. Additional clinical trials of coenzyme Q10 conducted in the United States, Great Britain, and Denmark had similar results; there was notable improvement in several cardiac parameters when coenzyme Q10 was used in conjunction with conventional therapies.
Because low magnesium levels are associated with frequent arrhythmias and higher mortality in patients with CHF, patients may benefit from magnesium therapy, which improves hemodynamic function and controls arrhythmias. There is little clinical evidence that magnesium therapy alone will provide substantial improvement in the overall condition of patients with CHF. However, in a recent study at the Arizona Heart Institute, patients with CHF who received oral magnesium oxide showed significant improvement in heart rate, mean arterial pressure, and exercise tolerance.
The use of human growth hormone may be of significant value in the treatment of idiopathic dilated cardiomyopathy (IDC) and CHF. A recent study of seven patients with IDC and moderate to severe CHF evaluated the effects of human growth hormone. The patients were given 14 international units (IU) of growth hormone in conjunction with conventional treatments for 3 months. Use of the hormone was discontinued for an additional 3 months. The results of the study indicated that growth hormone improved cardiac output and clinical symptoms, doubled ventricular mechanical function, and increased exercise capacity. After discontinuation of growth hormone, many of the beneficial effects were partially reversed. A second study had similar results; the researchers concluded that growth hormone, used in addition to conventional therapies, reduced the workload of the myocardium and deactivated the levels of the neurohormone aldosterone. The drawback to the use of human growth hormone in the treatment of CHF and IDC is its cost. For patients who cannot afford this therapy, 6 to 10 grams daily of arginine, an amino acid, may help to improve cardiac output.
The amino acid carnitine may be used in the treatment of IDC. In one study of children with IDC, supplemental doses of L-carnitine produced favorable results, in particular, improved left ventricular ejection fraction. There is some indication that L-carnitine, used in conjunction with taurine (a derivative of cysteine, an amino acid), coenzyme Q10, magnesium, chromium, and potassium, may be beneficial in patients with CHF. High intakes of fish oil may also provide some improvement of myocardial workload while reducing blood viscosity and the risk of arrhythmias. Prior to using any adjunctive therapies, patients should consult with their cardiologist regarding potential benefits and risks derived from the use of these therapies.
Chelation therapy may also be beneficial in treating CHF. Chelation increases blood flow, particularly to tiny arterioles.Summary
Congestive heart failure is a debilitating disease that is the most common cause for hospitalization in patients 65 or older. The risk factors for developing CHF are hypertension, diabetes, and other types of cardiac disease. Cardiomyopathy is a related condition in which the heart muscle is weakened or damaged. CHF and cardiomyopathy cause the heart to work much harder than normal. The goal of the various therapies used in the treatment of these diseases is to decrease the cardiac workload, reduce the risk of arrhythmias, increase cardiac function and hemodynamics, and improve the overall quality of life. Conventional medications used in the treatment of these diseases include diuretics, beta-blockers, antihypertensives, ACE inhibitors, and digoxin, among other medications. Recent studies indicate that coenzyme Q10, human growth hormone, taurine, magnesium, and L-carnitine can be of substantial benefit in the treatment of CHF and IDC when used as adjunctive therapies. Chelation therapy may be beneficial. Patients who do not respond well to medication may benefit from other types of therapy such as LVAD devices and mitral valve surgery. Organ transplantation may be the last option for a number of patients with CHF or cardiomyopathy. Prior to considering any adjunctive therapy, consult with your cardiologist. Here is a review of the treatment options:
- Alpha-lipoic acid: therapeutic dosage is 500-1000 mg daily and a preventive dose is 250-500 mg a day. Alpha-lipoic acidis an antioxidant and antidiabetic; is beneficial in congestive heart failure and stroke prevention, hypercholesterolemia, and hypertension; and inhibits protein glycation.
- L-Carnitine: clinical trials use 1500-3000 mg daily; preventive dosage, 600-1500 mg a day.
L-Carnitine has been shown to benefit patients with IDC (particularly children) by increasing left ventricular function.
- Coenzyme: 30-400 mg a day, depending upon the amount of cardiac support required. (Higher doses require physician supervision.) Coenzyme Q10 reduces angina attacks, arrhythmias, congestive heart failure, periodontal disease, and heart valve irregularities; lowers blood pressure; is protective to smokers; and supplies energy to the heart.
- Essential fatty acids: Perilla oil, 1000-mg capsules, provides 550-620 mg of alpha-linolenic acid, a precursor to EPA and DHA. Use 6 capsules a day. Blends of fish oils are available, supplying varying amounts of EPA and DHA. Borage oil is a source of gamma-linolenic acid (GLA). A supplement called Super GLA/DHA provides high concentrations of GLA from borage oil, along with DHA and EPA from fish oil extract. Essential fatty acids modulate blood lipids and body weight; improve heart function; lessen risk of restenosis and strokes; inhibit platelet clumping; have hypotensive and anti-inflammatory activity; reduce fibrinogen, homocysteine, and C-reactive protein levels; and improve insulin sensitivity.
- Hawthorn berry: 250-900 mg a day. Hawthorn berry is an antioxidant, antihypertensive, diuretic, and an aid to weight loss; reduces hypoxia and premature ventricular contractions; lowers cholesterol; is beneficial in congestive heart failure; acts as a vasodilator, ACE inhibitor, and calcium antagonist; and increases exercise tolerance.
- Growth hormone, when used in conjunction with conventional medications, was proven to increase cardiac output, particularly left ventricular function. The recommended dosage for growth hormone is 1 to 2 IU daily, or as recommended by a cardiologist.
- In lieu of growth hormone, arginine may provide the same benefits. Daily dosage of arginine 1800 mg of L-arginine 3 times a day or 4500 mg before bedtime. .L-arginine dilates blood vessels; reduces the atherogenesity of atherogenic foods; and mimics the actions of nitroglycerine.
- Selenium: 200-300 mcg a day; preventive dose, 200 mcg a day. Selenium is protective against cardiomyopathy and is beneficial in ventricular tachycardia, hyperlipidemia, congestive heart failure, and diabetes.
- Taurine: 1500-4000 mg in divided dosages dailyis hypotensive; arouses the parasympathetic nervous system; is beneficial in congestive heart failure and arrhythmias; and has blood thinning and diuretic properties; suggested dosage.
- Magnesium: 1000-1500 mg. When used in conjunction with other therapies, magnesium can improve cardiac hemodynamics and reduce the risk of arrhythmia in patients with CHF. Patients may want to consider taking magnesium-rich Life Extension Mix. The recommended dose is 3 tablets, 3 times daily.
- Thiamine (vitamin B1):Some patients may realize benefit from 200-250 mg of thiamine a day; refractory cardiac arrhythmias may require 500-1000 mg a day.Thiamine reduces cardiac arrhythmias, palpitations, congestive heart failure, and elevated venous pressure.
- Tocotrienols: daily dosage is 100 IU mixed tocopherols and 100 IU tocotrienols if the person is healthy, young, and without a family history of heart disease, and 200 IU of mixed tocopherols and 200 IU of tocotrienols for young adults with some cardiac risk factors or healthy people (50 years of age) without risk factors. 400 IU of mixed tocopherols and 400 IU of tocotrienols for people who have a personal or family history of cardiac disease. This dosage is appropriate for senior subjects and severely stressed or poorly nourished individuals. Tocotrienols inhibit platelet-clumping; reduce cholesterol; and have antioxidant activity.
- Vitamin D: 400 IU a day; if housebound, use 800 IU a day. Vitamin Dappears to lower risk of heart attack in older women; suggested dosage.
- Vitamin E: preventive and therapeutic dosage 400-1200 IU of dry powder vitamin E daily. Vitamin E assists in preventing plaque formation; protects LDL from oxidation; strengthens blood vessels; prevents blood viscosity; is beneficial in atrial and ventricular fibrillation; reduces C-reactive protein; and is considered an antidiabetic nutrient;
- Consult the protocols relating to the underlying causes of CHF (e.g. the Hypertension, Diabetes, Atherosclerosis protocols).
Conventional medications for the treatment of CHF and cardiomyopathy include diuretics, antihypertensive agents, digoxin, ACE inhibitors, beta-blockers, aspirin, and calcium antagonists, among other medications.
- Cardiac transplantation may be necessary for patients who do not respond to medications.
- New treatment options include the use of LVAD devices and mitral valve repair.
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