Congestive Heart Failure

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	Congestive Heart Failure

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	Congestive heart failure (CHF) is a serious condition in which the heart is not pumping well enough to meet the body’s demand for oxygen. This condition got its name because the heart is failing to pump efficiently, which often results in congestion of the lungs. As a result, the heart tries to overcompensate for the problem, which only makes the problem worse. Conditions that can lead to CHF include coronary artery disease, hypertension, heart attacks, cardiomyopathy, heart valve disease and infections, congenital heart disease and pulmonary hypertension. The initial symptoms of CHF, such as swelling of the ankles, seems so minor that patients may not seek treatment until significant heart damage has already been done. Once they seek medical help, a number of different conventional treatments may be prescribed. These include medications such as diuretics and invasive procedures such as a balloon angioplasty with coronary stenting. Severe cases may require surgery. According to current statistics from the American Heart Association, 550,000 new cases of CHF are diagnosed in the United States every year, including 1% of people over the age of 65. Of all newly diagnosed patients, 50% of CHF patients die within 5 years of diagnosis. Males and females appear to be affected about equally, but somewhat more women die from the condition. There are three general types of CHF. Diminished force of contraction of ventricles due to primary heart muscle diseases (cardiomyopathies) or coronory artery disease Mechanical failure in filling the ventricles during diastole due to narrowing of the mitral valve opening (mitral stenosis) or accumulation of fluid in the pericardium (pericardial tamponade) Overloading of the ventricles during systole due to: -high blood pressure (hypertensive cardiovascular disease) -narrowing and obstruction of aortic valve (aortic stenosis) -incomplete closure of aortic valve (aortic valvular regurgitation) -congenital defect in ventricular septum (ventricular septal defect) If the force of contraction is decreased only moderately, the heart can meet the demand provided there is no excessive stress or exercise. This is called compensated heart failure. Congestive (decompensated) heart failure occurs when force of contraction is decreased further. The primary signs and symptoms of decompensated CHF include: tachycardia increased exercise intolerance shortness of breath (dyspnea) peripheral and pulmonary edema cardiac enlargement (cardiomegaly) low blood pressure (hypotension) marked urine retention Left ventricular failure results in pulmonary congestion and edema and pleural effusion. This can be caused by aortic or bicuspid valvular disease, coronary heart disease and hypertension. Right ventricular failure results in fluid accumulation and congestion in the liver and legs. This can be caused by chronic lung disease and pulmonary hypertension or pulmonary or tricuspid valvular disease. Biventricular failure results in symptoms of both and may be caused by myocarditis, idiopathic cardiomyopathies or right -sided failure secondary to left-sided heart failure.

Signs, symptoms & indicators of Congestive Heart Failure:

Symptoms - Respiratory

Easily being short of/always being short of breath or normal breathlessness

Air hunger

Conditions that suggest Congestive Heart Failure:

Metabolic

Edema (Water Retention)

Organ Health

Kidney Weakness / Disease

Renal insufficiency due to underperfusion from a failing heart is more widespread than commonly thought.

Uro-Genital

Nocturia

Edema fluid that collects in tissues during the day due to heart failure can result in increased night time urination.

Risk factors for Congestive Heart Failure:

Lab Values - Chemistries

Elevated BUN

Elevated creatinine

Metabolic

Hemochromatosis (Iron overload)

Congestive heart failure occurs in about 7% of symptomatic patients with hemochromatosis. If untreated, patients may develop an acute onset of severe congestive heart failure with rapid progression to death.

Organ Health

Pancreatitis

Symptoms - Food - Beverages

Counter-indicators:

Moderate/low alcohol consumption

A study found that elderly people who drank at least 1.5 drinks per day had a risk of heart failure 47% lower than abstainers, regardless of age, race, blood pressure, history of diabetes, smoking and other factors.

Studies do not justify advising lifelong nondrinkers to start drinking for health, especially because most have good reasons for abstaining. People with liver disease or a history of alcohol abuse should not drink at all, while those with diabetes and hypertension may partake in light alcohol consumption.

Tumors, Malignant

Carcinoid Cancer

Metastatic carcinoid disease can result in congestive heart failure by causing progressive fibrosis of the right-sided chambers and valves.

Congestive Heart Failure suggests the following may be present:

Nutrients

Vitamin D Requirement

Various studies show that vitamin D deficiency is widespread among the critically ill and suggest that that vitamin D deficiency may contribute to the inflammatory basis of various illnesses. Early in 2004, researchers studied patients with congestive heart failure and found elevated levels of TNF, another marker of inflammation. They also found critically low levels of calcidiol [25(OH)D], the only reliable marker of vitamin D, and even found low levels of calcitriol, the active form of vitamin D that is usually low only in those who are severely vitamin D deficient.

Congestive Heart Failure can lead to:

Organ Health

Kidney Weakness / Disease

Renal insufficiency due to underperfusion from a failing heart is more widespread than commonly thought.

Recommendations for Congestive Heart Failure:

Amino Acid / Protein

L-Carnitine

Carnitine seems to help people who have suffered congestive heart failure. [Drugs 34 1987: pp.1-24, Arzneim Forsch 42 1992: pp.1101-4]

Taurine

Researchers at the University of South Alabama found that congestive heart failure responds favorably to taurine therapy. [Amino Acids 2000; 18(4): pp.305-18]

Botanical

Hawthorn (Crataegus oxycantha)

In 1,011 patients with stage II cardiac insufficiency, a standardized hawthorn extract containing 84mg of oligomeric procyanidins improved ejection fraction and resting pulse rate, and produced a reduction in cardiac arrhvthmias. Duration of the study was 24 weeks. [Eur J Heart Fail 2000;2(4): pp.431-437]

Clinical trials with an extract (WS 1442) have successfully demonstrated improved cardiac function and improved quality of life primarily in patients with early stage CHF. For the treatment of early stage CHF, the effective daily dosage of WS 1442 (standardized to 18.75% oligomeric procyanidins) has ranged from 160-900 mg per day, divided in 2-3 doses. Benefit has been shown in the 160-480mg per day range. [Fortschr Med 1996;114: pp.291-6]

Diet

Increased Fruit/Vegetable Consumption

Whole fruit and fruit and vegetable juice, both high in potassium, are recommended by some doctors for congestive heart failure (CHF). This dietary change should, however, be discussed with a healthcare provider because several drugs given to people with CHF can actually cause retention of potassium, making dietary potassium, even from fruit, dangerous. Bananas are a rich source of potassium and need to be avoided in persons taking potassium-sparing diuretics.

Drug

Conventional Drugs / Information

Prescription drugs are part of a program used to treat CHF. Such a program should consider:

Reducing the workload of heart (limit activity level, reduce weight and control hypertension)
Using diuretics (removal of retained salt and water) and restrict sodium (low salt diet)
Using angiotensin-converting enzyme inhibitors (decreases afterload and retained salt and water)
Using digitalis (positive inotropic effect on depressed heart)
Using vasodilators (decreases preload & afterload)

Extract

D-Ribose

Hormone

Growth Hormone

A small study of patients with congestive heart failure who received growth hormone at 4IU subcutaneously every other day, compared to patients who received a placebo, showed that growth hormone corrected endothelial dysfunction and vasodilatation in subjects with congestive heart failure. [J Am Coll Cardiol, Jan. 2, 2002;39(l): pp.90-95]

Mineral

Salt Intake Reduction

People with CHF should follow a low-salt diet. Salt causes retention of water which may result in edema. Talk to your doctor about salt substitutes because they contain potassium and may not be a good idea for you to take. This will depend on your kidney function and what drugs you are taking. Some people need extra potassium but others don’t.

Nutrient

CoQ10 (Ubiquin-one/ol)

CoQ10 is known to be highly concentrated in heart muscle cells due to the high energy requirements of this cell type. The great bulk of clinical work with CoQ10 has focused on heart disease. Specifically, congestive heart failure (from a wide variety of causes) has been strongly correlated with significantly low blood and tissue levels of CoQ10 [Proc. Natl. Acad. Sci., U.S.A., vol. 82(3), pp. 901-904].

The severity of heart failure correlates with the severity of CoQ10 deficiency [Drugs Exptl. Clin. Res. X(7) pp.497-502]. This CoQ10 deficiency may well be a primary causative factor in some types of heart muscle dysfunction while in others it may be a secondary phenomenon. Whether primary, secondary or both, this deficiency of CoQ10 appears to be a major treatable factor in the otherwise inexorable progression of heart failure.

The efficacy and safety of CoQ10 in the treatment of congestive heart failure, whether related to primary cardiomyopathies or secondary forms of heart failure, appears to be well-established.

Pantethine

Meyer's

KEY

		Weak or unproven link
		Strong or generally accepted link
		Strongly counter-indicative
		May do some good
		Likely to help
		Highly recommended

GLOSSARY

Acute: An illness or symptom of sudden onset, which generally has a short duration.

Aortic stenosis: Narrowing of the aortic valve of the heart.

Cardiac: Pertaining to the heart, also, pertaining to the stomach area adjacent to the esophagus.

Cardiomegaly: Enlargement of the heart.

Cardiovascular: Pertaining to the heart and blood vessels.

Chronic: Usually Chronic illness: Illness extending over a long period of time.

Chronic Renal Failure: (CRF) Irreversible, progressive impaired kidney function. The early stage, when the kidneys no longer function properly but do not yet require dialysis, is known as Chronic Renal Insufficiency (CRI). CRI can be difficult to diagnose, as symptoms are not usually apparent until kidney disease has progressed significantly. Common symptoms include a frequent need to urinate and swelling, as well as possible anemia, fatigue, weakness, headaches and loss of appetite. As the disease progresses, other symptoms such as nausea, vomiting, bad breath and itchy skin may develop as toxic metabolites, normally filtered out of the blood by the kidneys, build up to harmful levels. Over time (up to 10 or 20 years), CRF generally progresses from CRI to End-Stage Renal Disease (ESRD, also known as Kidney Failure). Patients with ESRD no longer have kidney function adequate to sustain life and require dialysis or kidney transplantation. Without proper treatment, ESRD is fatal.

Congestive: Pertaining to accumulation of blood or fluid within a vessel or organ.

Diabetes Mellitus: A disease with increased blood glucose levels due to lack or ineffectiveness of insulin. Diabetes is found in two forms; insulin-dependent diabetes (juvenile-onset) and non-insulin-dependent (adult-onset). Symptoms include increased thirst; increased urination; weight loss in spite of increased appetite; fatigue; nausea; vomiting; frequent infections including bladder, vaginal, and skin; blurred vision; impotence in men; bad breath; cessation of menses; diminished skin fullness. Other symptoms include bleeding gums; ear noise/buzzing; diarrhea; depression; confusion.

Diastole: Relaxation phase of the heart beat.

Diuretic: An agent increasing urine flow, causing the kidneys to excrete more than the usual amount of sodium, potassium and water.

Dyspnea: Difficult breathing.

Edema: Abnormal accumulation of fluids within tissues resulting in swelling.

Hemochromatosis: A rare disease in which iron deposits build up throughout the body. Enlarged liver, skin discoloration, diabetes mellitus, and heart failure may occur.

Hypertension: High blood pressure. Hypertension increases the risk of heart attack, stroke, and kidney failure because it adds to the workload of the heart, causing it to enlarge and, over time, to weaken; in addition, it may damage the walls of the arteries.

Hypotension: Low blood pressure.

Idiopathic: Arising spontaneously or from an obscure or unknown cause.

Pulmonary: Pertaining to the lungs.

Pulmonary Edema: Accumulation of fluid in the lung.

Stenosis: (Esophageal, GI tract): Narrowing.

Systole: Contraction of the heart.

Tachycardia: Excessively rapid heart rate.

TNF: Tumor Necrosis Factor. TNF-alpha is a pro-inflammatory cytokine significantly elevated in all leukemias except for AML and myelodysplastic syndromes.

Vitamin D: A fat-soluble vitamin essential to one's health. Regulates the amount of calcium and phosphorus in the blood by improving their absorption and utilization. Necessary for normal growth and formation of bones and teeth. For Vitamin D only, 1mcg translates to 40 IU.