HEART FAILURE
Congestive heart failure is the sustained reduction in the ability of the heart muscle to pump blood. This disorder tends to progress with time and has a poor prognosis. By 5 years after diagnosis, 50% of people will die of heart failure. Enlargement of the heart (cardiomegaly) is common and is the attempt of the heart to meet the demands of the body. Thickening of the main heart pumping chamber (left ventricular hypertrophy) is an early adaptation that precedes failure.
Symptoms of heart failure include shortness of breath upon exertion, shortness of breath when lying down, edema (fluid retention) and weight gain due to edema. The diagnosis can be confirmed by physical exam findings, chest x-rays, EKG and echocardiogram (ultrasound wave picture of heart size and motion). It affects over 1 million Americans and is the most common reason for hospitalization in the elderly. Risk factors for heart failure include high blood pressure, coronary artery disease, chronic obstructive pulmonary disease, alcohol abuse, viral infections, heavy metal toxicity and nutritional deficiencies.
Excessive salt intake, low levels of potassium and magnesium and selenium deficiency are associated with heart failure. Oxidative stress on heart cells may be a factor and low levels of antioxidants from a deficient diet may be a factor. Adequate energy production within heart cell mitochondria is essential for normal heart function. Low levels of energy producing factors coenzyme Q10, taurine and L-carnitine are associated with heart failure. Untreated hypothyroidism can also cause heart failure.
Conventional treatment includes digitalis to improve contraction of heart muscle, diuretics to eliminate excessive fluid, nitrates to open heart arteries, ACE inhibitors (a particular class of blood pressure medication) to reduce load on the heart, beta-blockers to slow heart rate and oxygen if levels are low. Side effects from medication are frequent and often serious. Aggressive treatment to lower high blood pressure and other inciting causes is necessary to prevent rapid progression. Exercise was not recommended until recent trials showed a positive benefit.
Alternative therapies show much promise in relieving symptoms and extending life. Antioxidants such as vitamin A, C, and E should be provided in whole foods and whole food supplements. Synthetic vitamins may actually be detrimental since they do not include the entire vitamin complex. Magnesium and potassium should be supplemented, especially on those who take diuretics and lose these essential minerals. Thiamine, a B vitamin, is depleted by diuretics and should be given.
Omega-3 oils are protective of heart arteries and can be given in 1-2 grams daily.
Supplements of coenzyme Q10, taurine and l-carnitine are likely to improve energy production within the heart cells and slow disease progression. A number of herbs show promise in treatment, especially hawthorn berry. Acupuncture and homeopathy may be helpful but clinical trials are inadequate to recommend it at present.
Research shows that the body responds to early heart failure by increasing the sympathetic tone of the nervous system. This short-term response by the body is detrimental in the long term and causes the failure to progress. Patients who can learn to decrease sympathetic tone (the fight or flight response of the body) will help the heart by causing less resistance to pumping of the blood. This skill can be learned through biofeedback and meditation.
Addressing unresolved emotional issues may also be of benefit. People with heart failure may be in an unfulfilling relationship where their “heart is not in it”. They may have severe unresolved grief and a “broken heart”. Counseling and personal growth work can be helpful.
Daniel Blodgett MD