Chronic Heart Failure

Chronic Heart Failure Overview:

Chronic heart failure is a progressive disease affecting the hearts ability to pump blood to the rest of the body. The issue can arise from either systolic or diastolic dysfunctions, and may even occur together. With either case, the stroke volume of the heart is reduced, as well as cardiac reserve.

Although the end result is virtually the same, there are some differences depending on which part of the heart is affected.

 

Aetiology:

+ Systolic Dysfunction

Involves inadequate ventricular contraction. This results in reduced ejection fraction. This condition can affect either the left ventricle or the right ventricle. Left ventricular failure almost always leads to right ventricular failure eventually.

Causes Include:

  • Myocardial infarction
  • Mycarditis
  • Dilated Cardiomyopathy

Signs & Symptoms:

  • Left Ventricular Failure:
    • Pulmonary oedema
  • Right Ventricular Failure:
    • Peripheral oedema
    • Liver dysfunction
    • Ascites

+ Diastolic Dysfunction

Involves impaired ventricular filling. The ejection fraction will remain close to normal with this condition.

Causes Include:

  • Valvular Disease
  • Prolonged Hypertension
  • Hypertrophic Cardiomyopathy
 

Symptoms:

Shortness of Breath

Swollen Ankles

Oedema Around The Abdomen

Weight Gain

Symptom

Loss of Appetite

Dizziness

Coughing

 

Diagnostic Considerations:

Functional Classification System

From The New York Heart Association

Class Description
Class 1 Patients have cardiac disease but without the resulting limitations of physical activity. Ordinary physical activity does not cause undue fatigue, palpitation, dyspnoea or anginal pain.
Class 2 Patients have cardiac disease resulting in slight limitation of physical activity. They are comfortable at rest. Ordinary physical activity results in fatigue, palpitation, dyspnoea or anginal pain.
Class 3 Patients have cardiac disease resulting in marked limitation of physical activity. They are comfortable at rest. Less than ordinary physical activity causes fatigue, palpitation, dyspnoea or anginal pain.
Class 4 Patients have cardiac disease resulting in inability to carry on any physical activity without discomfort. Symptoms of cardiac insufficiency or of the anginal syndrome may be present even at rest. If any physical activity is undertaken, discomfort is increased.

Constituents

Interpretations
Serum Creatinine High levels may indicate kidney dysfunction as the cause for high blood pressure and fluid buildup other than the heart.
Blood Urea Nitrogen (BUN) High BUN may indicate kidney damage. This may be the result of severe heart failure, or a byproduct of ACE inhibitor usage.
Brain Natriuretic Peptide (BNP) BNP is made in the heart and should only be present in small amounts. High levels mau indicate heart failure.
Serum Albumin Low levels of albumin could indicate intestinal disorders (hypoalbuminemia), liver problems, or kidney disease as a cause for fluid buildups instead of the heart.
TSH, T3, Reverse T3, T4 Hyper or hypothyroid may cause cardiac arrythmias.
Urine Analysis Protein or blood in the urine may indicate kidney disorders.
Blood Glucose High levels of blood glucose may indicate diabetes, a major risk factor for heart disease.
Liver Function Testing heart disease may lead to fluid buildup in the liver.
Electrolytes Useful for assessing side effects of diuretic and ACE inhibitor medications.
Prothrombin Time (PT) Provides insight to clotting ability of the blood. Useful for assessing side effects of blood thinner medications.
 

Therapeutic Aims:

1. Improve Ventricular Competence

  • Positive Inotropic Substances (Crataegus oxycanthus, Astragalus membranaceus)
  • Vascular Tonics (Aesculus hippocastanum, Ginkgo biloba, Panax ginseng)
  • Antioxidants (Vitis vinefera)

2. Improve Myocardial Energy Metabolism

  • Nutritional (CoQ10, Magnesium, Taurine, B Vitamins)

3. Reduce Pulmonary Oedema or Peripheral Oedema

  • Diuretics (Taraxicum officinale, Olea europa)

4. Manage Risk Factors

  • Hypotensives (Crataegus oxycanthus, Allium sativum)
  • Hypoglycemics (Panax ginseng, Gymnema sylvestris, Stevia rebaudiana)
  • Coronary Vasodilators (Crataegus oxycantha)

7. Decrease Stress

  • Adaptogens (Panax ginseng, Eleutherococcus senticosus)
  • Thymoleptics (Melissa officinalis, Rosa centrifolia)
  • Antidepressants (Hypericum perforatum)
  • Anxiolytics (Passiflora incarnata, Zizyphus jujube, Piper methysticum)
 

Differential Diagnosis:

  • Cardiomyopathy
 

Comorbidities:

  • Sudden cardiac death
  • Hypertension
  • Fatty liver disease
  • Diabetes
  • Hypercholesterolemia
  • hypertriglyceridemia
 

Cautions:

Avoid using Inula racemosa or Valeriana officinalis in larger doses as they may reduce stroke volume further.

 

Herbs For Chronic Heart Failure:

 

Author:

Justin Cooke

The Sunlight Experiment

Updated: March 2018


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