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December 2003

Natural Approaches In the Treatment of Congestive Heart Failure
By Dr. Sergey A. Dzugan

Tens of millions of people worldwide including nearly 5 million Americans suffer from congestive heart failure (CHF), and the number of CHF patients has grown markedly over the past 40 years. 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. Approximately 20% of CHF patients will die within one year of diagnosis, 50% will die within five years, and patients’ quality of life often is poor even when therapy is maximized.

Heart failure is the leading cause of hospitalization in people over the age of 65, and the risk for developing the disease increases with age. Since the 1970s, heart failure has been on the increase because the number of people aged 65 or older has grown. Because this population is expected to continue to grow, an increase in cardiovascular morbidity is predicted.1 Most experts believe that the incidence of CHF will continue to grow as the population ages and more people survive heart attacks.2.

Conditions Leading to CHF
CHF is a very serious condition in which the heart does not pump enough blood to meet the body’s needs. This can lead to congestion within the lungs, as blood flows backward from the heart. When this congestion begins, the patient may experience clinical symptoms of varying severity. CHF is a multi-faceted condition that involves several organ systems, including the heart, kidneys, vascular system, and brain, as well as various neurohumoral factors.

CHF is the result of pathophysiological changes in the functions of the heart caused by underlying conditions such as the long-term effects of high blood pressure (hypertension), previous heart attack (myocardial infarction), arrhythmia, coronary heart disease, heart valve disorders, cardiomyopathy, or chronic lung disease. These conditions produce CHF by affecting the ability of the heart to contract properly. Other conditions that may lead to CHF include congenital heart disease, diabetes, anemia, obstructive sleep apnea, lupus, rheumatoid arthritis, hyperthyroidism, certain chemo-therapy drugs, alcohol abuse, and abuse of drugs such as amphetamines and cocaine. Additionally, the risk of developing CHF is increased by lifestyle and dietary factors such as smoking, obesity, lack of exercise, high salt intake, emotional distress, and fluid overload.

With CHF, the heart has to work harder to try to make up for its reduced pumping ability. The more the heart overworks, the more its pumping ability is compromised and the more likely serious pumping failure will occur. This increased workload can lead to dangerous physical changes such as enlargement of the heart, hypertrophy of the heart wall, tachycardia (rapid heart beat), and kidney malfunction.

Different Types of Heart Failure
The heart comprises two independent pumping systems, on the right side and left side of the heart. Each has two chambers, called the atrium and the ventricle. The ventricles are the major pumps in the heart. The right system receives blood from veins throughout the entire body. This blood has already circulated throughout the body and as a result is lacking in oxygen and rich in carbon dioxide. The left system receives the blood from the lungs. The left ventricle is the strongest of the heart’s pumps.

The two types of heart failure are distinguished by which side of the heart (left or right) is most affected. When the left side of the heart (left ventricle) cannot pump blood adequately from the heart to the rest of the body, the symptoms include shortness of breath, fatigue, and coughing (especially in a horizontal position). When the right side (right ventricle) is not working properly, the return venous blood is worsened, which results in fluid retention and the patient experiencing swelling in the legs and ankles.

CHF is further categorized according to which phase of the heart’s pumping cycle is more affected. The two types of CHF are systolic and diastolic. In systolic CHF, the heart is unable to pump adequate amounts of blood during its contraction (systole). Typical symptoms of systolic CHF are lung congestion and swelling of the lower extremities. In diastolic CHF, the heart is unable to relax between contractions (diastole) and does not allow enough blood to enter the ventricles. Symptoms are identical to those of systolic CHF.

The New York Heart Association developed the following classification system to grade CHF by severity of symptoms:

Class I. No limitation of physical activity. No shortness of breath, fatigue, or heart palpitations with ordinary physical activity.

Class II. Slight limitation of physical activity. Shortness of breath, fatigue, or heart palpitations with ordinary physical activity, but patients are comfortable at rest.

Class III. Marked limitation of activity. Shortness of breath, fatigue, or heart palpitations with less than ordinary physical activity, but patients are comfortable at rest.

Class IV. Severe to complete limitation of activity. Shortness of breath, fatigue, or heart palpitations with any physical exertion and symptoms appear even at rest.

Conventional and Complementary Treatment Options
Current CHF treatment options include both conventional and complementary approaches. Because this article focuses on natural agents for the treatment of CHF, we will consider only briefly conventional treatment of CHF.

Conventional Treatment
CHF is a particularly difficult malady, as no single drug can fully relieve its symptoms. The first step in managing CHF is to treat the primary conditions causing the disease. These typically include one or more of the following: coronary artery disease, valvular abnormalities, high blood pressure, arrhythmia, anemia, and thyroid dysfunction. Treating heart failure itself as early as possible offers the best chance for a longer and better-quality life.

Several classes of medication are used to treat heart failure: diuretics (which reduce fluid), ACE (angiotensin-converting enzyme) inhibitors (which open blood vessels), beta-blockers (which slow heart rate), digoxin (which increases the heart’s ability to contract), and vasodilators (agents that open blood vessels). Diuretics and ACE inhibitors have the best track record to date for treating CHF patients.

Depending on the severity of the damage and dysfunction, interventional procedures may be necessary, including balloon angioplasty, coronary stenting, coronary artery bypass surgery, heart valve surgery, pacemaker insertion, and heart transplantation.

Complementary Treatment
Complementary approaches to treating CHF include lifestyle modifications and alternative remedies or natural agents. First of all, the patient must be aggressive about maintaining a healthy, optimal weight to reduce unnecessary strain on the heart. Individuals with CHF must avoid heavy alcohol intake and restrict their salt intake. With worsening heart function, it may be necessary to limit sodium intake to 2 grams per day and ingestion of water to 1.5–2 liters per day. CHF patients also are advised to increase their use of monounsaturated oils, such as extra virgin olive oil,3 foods high in essential fatty acids,4-8 and fruits, vegetables,9-11 and fiber.12 Patients may be advised to increase their intake of garlic, onions, and celery, as these foods have been shown to lower blood pressure.

Supplementation with essential nutrients is critical for patients suffering from CHF. Vitamins and other nutrients serve as bioenergy carriers to millions of heart muscle cells. The natural approach focuses on improving myocardial energy production. Numerous clinical studies have demonstrated the value of vitamins and other nutrients in treating conditions such as shortness of breath, edema, and other symptoms of CHF. The most comprehensive clinical studies have tested coenzyme Q10 (CoQ10) and carnitine, both carrier molecules of bioenergy in the heart.13,14