Conditions

Heart Disease

Heart disease, a part of cardiovascular disease, is a general term that denotes disorders of the heart. There are numerous distinct disorders that fall into this category. This document focuses on angina, heart attack, heart failure, arrhythmias, myocarditis, and heart murmurs.

Angina:
Pain brought on when not enough oxygenated blood reaches the heart. It can be mild or severe. It can be caused by a blockage or by spasms of the coronary arteries.

Heart Attack:
In a heart attack, the amount of oxygenated blood that reaches the heart is so sharply reduced that areas of heart tissue die. The medical term for this process is myocardial infarction. The consequences of a heart attack can be very serious, depending on the extent and location of the damage to the heart.

Heart Failure:
Heart failure, also known as congestive heart failure, occurs when the heart is unable to pump sufficient oxygenated blood to fully supply the body. This leads to increased pressure, which forces fluid from the blood into the surrounding tissue. This fluid retention is what gives the condition its name. Heart failure can result from anything that causes damage to the heart. In some cases, the underlying cause is unknown.

Arrhythmias:
Arrhythmias are abnormal heartbeats. There are different types of abnormal rhythms, and different causes. They range in severity from almost totally insignificant to very serious. The seriousness of arrhythmias depends on how much they affect the amount of blood the heart can pump. In general, the most serious are those connected with the left ventricle.

Myocarditis:
Myocarditis is inflammation of the heart muscle. It can be due to infection but certain drugs, exposure to radiation, and toxins may also be involved.

Heart Murmurs:
A heart murmur is not a disorder but rather a sound that the heart makes.

Signs and Symptoms:

Heart Attack:

• Crushing or squeezing pain in the chest or upper abdomen
• Pain spreads to the neck and shoulders, down the arms, and to the back.
• Profuse perspiration
• Visible paling or graying of the skin
• Difficulty swallowing
• Drop in blood pressure
• Shortness of breath
• Dizziness
• Faintness
• Weak and rapid pulse
• Nausea
• Vomiting

Heart Failure:

• Weakness
• Fatigue
• Shortness of breath
• Kidney and liver function may be affected as well.

Arrhythmias:

• Symptoms can range from none at all, to palpitations, dizziness and fainting and even to sudden death.

Myocarditis:

• Chest pain
• Trouble breathing
• In some cases, heart failure can develop.

Diagnosis:
Diagnosis is done through a physical exam and complete review of patient history as well as various imaging and laboratory tests. These vary to some extent depending on the type of heart disease suspected.

Treatment Options:

Treatment ranges from emergency, life-saving techniques to prevention of further damage.

Traditional Treatments:

• A heart attack requires emergency medical intervention. It is best that a paramedic or other trained professional attend you as quickly as possible, rather than waiting for medical help until you arrive at the hospital ­ thus, calling an ambulance is well advised. Emergency personnel will immediately place you on monitoring equipment consisting of electrodes placed over the chest area. They will likely also establish IV access - so medications may be administered directly into the bloodstream. They will also give you oxygen. At this point, unless other intervention is deemed necessary, you will be driven to the emergency room.
• Ultrasound treatment to stop a heart attack in progress is a new technique being developed in Israel. In this procedure, doctors insert a catheter fitted with an ultrasound probe into an artery, position it at the blockage, and liquefy the clot with bursts of ultrasound.
  Even once the crisis has passed, a heart attack can leave a person with any of an array of arrhythmias. Some are not significant, while others can be quite serious and necessitate the use of any of several different kinds of drugs. Doctors are likely to recommend drug treatment only for the most serious arrhythmias or those that cause major symptoms.
• Coronary angioplasty can help restore normal blood flow to the heart. In this procedure, a balloon-tipped catheter is threaded into an artery that is partially blocked by plaque. The balloon is then inflated, pushing the plaque back and increasing the open space within the vessel. Unfortunately, in an estimated 30 to 50 percent of cases, the artery becomes blocked again within six months and the process must be repeated.
• Coronary artery bypass surgery is a procedure that brings blood to the heart by taking sections of blood vessels from elsewhere in the body and grafting them onto the coronary arteries to create detours around areas of blockage. This often improves quality of life but it does not address the underlying process that led to the blocked arteries in the first place. As a result, nearly 40 percent of bypassed vessels are diseased again within five years.
• For angina, relaxation and rest may be helpful. A doctor is also likely to prescribe nitrate drugs such as nitroglycerin (Nitro-Bid, Nitro-Dur, Notrostat) to be used as needed. Beta-blocking drugs, which lower the heart rate and heart-muscle load, may also be prescribed.
• Congestive heart failure is treated first with thiazide diuretics or a related drug, metolazone. These drugs increase the elimination of fluids from the body and ease the heart's workload. In mild cases of heart failure, diuretics may be the only treatment.
• For more serious heart failure, with poorer kidney function, a stronger class of drugs known as "loop" diuretics may be prescribed, either alone or in conjunction with the initial diuretic. Examples of loop diuretics include furosemide (Lasix), bumetanide (Bumex), and ethacrynic acid (Edecrin). If you must take these drugs it is vital that you also take potassium, as this important mineral is excreted in the urine along with the drug.
• Another type of diuretic, known as "potassium-sparing" diuretics, may be used as well. These are not as strong as other types, but they can further reduce fluid retention without causing additional losses of potassium, which can have serious consequences for the heart. This class of drugs includes spironolactone (Aldactone), triamterene (Dyrenium), and amiloride (Midamore).
• Angiotensin-converting enzyme (ACE) inhibitors are rapidly becoming standard treatment for heart failure. They work by altering hormone levels in the blood to cause the blood vessels to relax and dilate. This lowers blood pressure. Although other drugs can do this as well, ACE inhibitors tend to do it without causing the body to develop a tolerance for the drug.
• Nitroglycerin, or nitrate therapy, is another popular treatment that causes vasodilation (relaxation of the blood vessels). It is used primarily in the short-term, as tolerance is known to develop.
• Once the major drug used to treat heart failure, digitalis compounds (digitoxin, digoxin) are no longer as widely used. Recent studies have shown that these drugs ultimately have no effect on survival rate for people with heart failure. While the number of deaths from heart failure itself decreased with the use of digitalis, the death rate from arrhythmias increased, negating the positive effect. Moreover, these drugs must be taken at near-toxic levels to be effective.
• Many doctors recommend a daily aspirin as a preventative measure, particularly in people who have already had one heart attack. Aspirin thins the blood, making it less prone to clotting. Some are now saying, however, that relying on aspirin may not be sufficient. A new blood-thinning drug named clopidogren was shown to reduce the risk of new heart attacks and strokes by one third. The study also found that those who use aspirin are more likely to suffer digestive bleeding as a side effect than those who take clopidogren. Some people may benefit greatly from aspirin's anti-inflammatory effects, however. This is because low-level inflammation of the arterial walls has been found to contribute to coronary artery disease.
• Arrhythmias are treated with any of five different types of drugs, depending upon where the electrical activity is abnormal and the specific trait of the rhythm ­ whether it is too slow, too fast, or irregular. There are also pacemakers, electrical devices that can be implanted or worn externally to override the abnormal impulses within the heart. A technique called cardioversion may be used in some cases. This involves applying a controlled electrical shock to the chest region that may jolt the heart back into a more normal rhythm.
• High doses of magnesium may be effective in calming some arrhythmias.

Complementary and Alternative Therapies:

Alternative therapies are most appropriate to prevent heart disease, minimize damage from a heart attack, and reduce the risk of a future complications, once the patient has been properly diagnosed and stabilized. There are no substitutes for immediate and appropriate medical care with a presentation of chest pain and/or suspected heart attack or other forms of heart disease.

Nutritional Supplementation:

• Take a good multivitamin and mineral supplement. Choose a powdered or capsule form for best absorption.
• The antioxidant nutrients are very important. Take 5,000 IU of vitamin A, 15,000 IU of beta-carotene; 1,000 mg of vitamin C three times daily; 400 to 800 IU of vitamin E twice a day; and 200 mcg of selenium daily.
  Warning: If you are pregnant, intend to get pregnant or have liver disease consult your doctor before taking supplemental vitamin A. If you have high blood pressure limit you intake of supplemental vitamin E to a total of 400 IU daily. If you are taking blood thinners consult your doctor before taking supplemental vitamin E.
• Carnitine is very useful for its ability to improve cellular oxygenation, and can be helpful for angina, arrhythmias, and recovery from a cardiac episode such as a heart attack. Start by taking a dose of 250 to 500 mg of L-carnitine with breakfast. After one week, add a second dose, with lunch. After another week, add a third dose, so that you are taking 250 to 500 mg with each meal, and after still another week, add a fourth dose at bedtime.
• Essential fatty acids such as those found in black currant seed oil, borage oil, evening primrose oil, fish oil, and flaxseed oil help to prevent unnecessary blood clotting, reduce inflammation, and regulate blood pressure. Take 500 to 1,000 mg of any of these oils twice daily.
• Magnesium can stabilize an irregular heartbeat. Take up to 500 mg of magnesium daily. If you develop loose stools, reduce the dosage slightly until you arrive at the best dosage for your body.
• Zinc is an antioxidant that helps maintain proper immune function. Take 15 to 20 mg of zinc picolinate, aspartate, or gluconate twice daily. Take with food to prevent stomach upset. If you take over 30 mg of zinc on a daily basis for more than one month, you should also take 1 to 2 mg of copper each day to maintain a proper mineral balance.
• Alpha-linolenic acid (ALA) is an omega-3 fatty acid found to lower the risk of a fatal heart attack by over one-third in a long-term French study.
• Alpha-lipoic acid is an antioxidant that lowers LDL levels.
• Chinese red yeast rice extract promotes blood circulation and regulates cholesterol levels.
• Grape seed extract or Pycnogenol reduces the clotting tendency of the blood. Best used in combination with phosphatidyl choline, a natural component of lecithin.
• L-Arginine is an amino acid that boost production of nitric oxide, which dilates the arteries to allow better blood flow.
  Warning: If you are prone to herpes outbreaks, do not take L-arginine without L-lysine.
• Lecithin aids in lowering cholesterol levels.
• Potassium is needed to maintain regular heart rhythm and lower cholesterol.
• Selenium deficiencies have been implicated in heart disease.

Alternative Therapies:

• Artichoke leaf extract reduces blood cholesterol and protects the liver.
• Citrin inhibits the synthesis of fatty acids in the liver, thus helping to prevent the accumulation of potentially dangerous fats in the body.
• Cat's claw has the ability to inhibit the formation of blood clots. By increasing circulation and inhibiting inappropriate clotting, it may help to prevent stroke and reduce the risk of heart attack.
• Cordyceps is a Chinese herb that can slow the heart rate, increase blood supply to the arteries and heart, and lower blood pressure.
• Ginkgo biloba can benefit the cardiovascular system by preventing the formation of free radicals.
• Guggul, an Indian herb, lowers blood-fat levels while raising levels of the "good cholesterol", HDL.
  Warning: Do not take guggul if you have a thyroid disorder.
• Hawthorn increases blood flow and lowers blood pressure.
• Alfalfa, horsetail, nettle and pau d'arco are rich in minerals necessary for proper regulation of heart rhythm.
• Oat straw, passionflower, skullcap and wood betony are calming herbs that may help to regulate arrhythmias.
• Gotu kola, primrose, and rosemary are helpful in managing angina.
• Other herbs and herbal products beneficial for cardiovascular disease include barberry, black cohosh, butcher's broom, cayenne, dandelion, ginseng, motherwort, red sage, and valerian root.
  Warning: Do not use barberry or black cohosh during pregnancy. Do not use ginseng if you have high blood pressure.
• Arnica is a homeopathic remedy used to support recovery from heart attack.

General Recommendations:

• Address and eliminate all possible risk factors: pay attention to your diet, keep your weight down. Don't smoke, get regular exercise.
• Look into chelation therapy. This is a type of treatment in which a chemical agent is administered via IV and binds to minerals and metals, allowing the body to excrete them in urine. Tests have shown that many people experience distinct improvement in both exercise tolerance and blood-vessel blockage after this treatment.
• Include garlic and onions in your diet. They contain compounds that help to reduce serum cholesterol levels.
• Do not consume stimulants, such as coffee and black tea, which contain caffeine. Studies show that coffee increases stress hormones in the body, putting coffee drinkers at a greater risk of heart disease.
• Eliminate all sources of sodium from your diet.
• If you take a blood thinner such as warfarin or heparin, or even aspirin, limit your intake of foods high in vitamin K. Eating foods containing vitamin K increases the blood's tendency to clot, so they should be eaten only in small quantities.
• Learn all about any drugs that have been prescribed for you.
• Keep emergency and ambulance numbers easily accessible.
• Avoid stress and learn stress management techniques.

Warnings:

• Any suspicion that you may be having a heart attack means that you should call for emergency help immediately. Even if the pain eases and the symptoms fade, you need medical evaluation and attention.
• Avoid the herb ephedra (ma huang) and licorice; they can cause a rise in blood pressure.
• If you have cardiovascular disease, consult your doctor before beginning any new exercise program.
• If you are pregnant, intend to get pregnant or have liver disease consult your doctor before taking supplemental vitamin A.
• If you have high blood pressure limit you intake of supplemental vitamin E to a total of 400 IU daily.
• If you are taking blood thinners consult your doctor before taking supplemental vitamin E.
• If you are prone to herpes outbreaks, do not take L-arginine without L-lysine.
• Do not take guggul if you have a thyroid disorder.
• Do not use barberry or black cohosh during pregnancy.
• Do not use ginseng if you have high blood pressure.