Heart Failure

Heart failure – What is it and what causes it?

Heart failure is a progressive clinical condition caused by structural or functional abnormalities of the heart which results in reduced cardiac output.  It is a broad term that covers many different disorders that can affect the normal working order of the heart.  Essentially, heart failure means that your heart is not pumping blood around your body as effectively as it should.  This doesn’t mean that your heart has stopped working, but it does mean that your heart needs some support to help it work better specifically as without sufficient blood flow, all major body functions are disrupted.

Chronic heart failure is a long-term condition that often gets worse over time. It can’t be cured, but with treatment and lifestyle changes, many people can have a good quality of life.  It can occur at any age but is most common in older people and it quite often co-exists with other co-morbidities such as chronic kidney disease, atrial fibrillation, hypertension, dyslipidaemia, obesity, diabetes mellitus and chronic pulmonary disease.  The presence of any of these conditions will most definitely affect the management and treatment of the heart failure.

The heart is a very complex organ and there are lots of components that can be affected by various disorders which could contribute to heart failure.  Diagram 1 below identifies the arteries, veins, valves, atriums and ventricles.

Diagram 1:

 

Heart failure

 

There are lots of reasons why you may develop heart failure. It can be sudden, or it can happen slowly over months or even years.

The most common causes are:

  • heart attack – this can cause long-term damage to your heart, which can affect how well the heart can pump.
  • High blood pressure – this can put extra strain on the heart, which over time can lead to heart failure.
  • Cardiomyopathy – a disease of the heart muscle. There are different types which can either be inherited or caused by other things, such as viral infections.

Heart failure can also be caused by:

  • Damaged or diseased heart valves
  • An abnormal heart rhythm (arrhythmia)
  • Congenital heart conditions – heart problems that you’re born with
  • A viral infection affecting the heart muscle
  • Some cancer treatments such as chemotherapy
  • Excessive alcohol consumption
  • Anaemia – a lack of oxygen carrying haemoglobin or red blood cells in your blood
  • Thyroid gland disease.

 

Symptoms of heart failure

The symptoms of Heart Failure can be quite vague and at first presentation it is often difficult to ascertain whether they are indeed symptoms specifically of Heart Failure or symptoms of something completely different.   The symptoms can start suddenly or develop gradually over weeks or months.  Allopathic doctors will use a variety of tests to enable a confirmed diagnosis, including blood screening, Electrocardiogram (ECG), Echocardiogram, breathing tests/stress examinations, chest x-ray/angiogram.

The main symptoms and most common are:

  • Shortness of breath when you are being active or at rest.
  • Swollen feet, ankles, stomach and around the lower back area.
  • Feeling unusually tired or weak.

These symptoms occur because your heart is not able to pump blood around the body efficiently. This can lead to a build-up of fluid that backs up into the lungs, which causes breathlessness.  Also, because the heart is not pumping properly it can cause fluid retention, leading to swelling in your legs, ankles, feet or in the small of your back or abdomen.  You may also feel extremely tired because your heart is not able to deliver enough blood and oxygen to the muscles in your body.

Table 1 below shows a list of symptoms and signs which are both typical and less typical of heart failure.  As you can see these could easily be misinterpreted for other conditions, however if patient is presenting with 3 or more of the typical symptom/signs, it would be acceptable to continue with tests for a confirmed diagnosis of heart failure.

 

 

Table 1: Symptoms and signs typical of heart failure

Symptoms

Typical Less typical

 

Breathlessness Nocturnal cough
Orthopnoea Wheezing
Paroxysmal nocturnal dyspnoea Weight gain (>2 kg/week)
Reduced exercise tolerance Weight loss (in advanced heart failure)
Fatigue, tiredness, increased time to recover after exercise Bloated feeling
Ankle swelling Loss of appetite
  Confusion (especially in older people)
  Depression
  Palpitations
  Syncope (fainting)

 Signs

More specific

 

Less specific
Elevated jugular venous pressure Peripheral oedema (ankle, sacral, scrotal)
Hepatojugular reflux Pulmonary crepitations
Third heart sound (gallop rhythm) Reduced air entry and dullness to percussion at lung bases (pleural effusion)
Laterally displaced apical impulse Tachycardia (fast heartbeat)
Cardiac murmur Irregular pulse
  Tachypnoea (>16 breaths/min) (fast breath)
  Hepatomegaly (enlargement of liver)
  Ascites (abnormal build-up of fluid in abdomen)
  Tissue wasting (cachexia)

 

 Stages of Heart Failure

Heart failure is measured in stages indicating the severity of the individual’s condition at any specific time. The stages are from 1-4, with 1 being the least severe and 4 being the most severe.  Table 2 shows the New York Heart Association classification which is used for this assessment.  For correct treatment it is important to understand what level of discomfort the patient is experiencing, and the following table assists with this.

 

Table 2: New York Heart Association classification
Class  

Symptoms

 

I No limitation: ordinary physical exercise does not cause undue fatigue, dyspnoea or palpitations.

 

II Slight limitation of physical activity: comfortable at rest but ordinary activity results in fatigue, palpitations or dyspnoea

 

III Marked limitation of physical activity: comfortable at rest but less than ordinary activity results in symptoms.

 

IV Unable to carry out any physical activity without discomfort: symptoms of heart failure are present even at rest with increased discomfort with any physical activity.

 

 

Treatments

The common treatments include:

  • Lifestyle changes
    • Healthy Diet
    • Stopping smoking
    • Exercising regularly
    • Limiting alcohol consumption
    • Reducing anxiety
  • Medicines
  • Drugs (see table 3 for Drugs used and their actions)
  • Devices
  • Implanted in chest to help control rhythm
  • Surgery
  • Bypass operation
  • Heart transplant

 

In most cases a combination of these treatments will be necessary to manage a patient’s condition successfully and this would be the case for both Allopathic and Homeopathic treatment.  The following Table 3 identifies some of the more common drugs prescribed by allopathic doctors, showing their action and side effects.

Table 3: List of common medication
Medication Action Brand name Side Effects
ACE Inhibitor (Angiotensin-converting enzyme) Relaxes and opens up blood vessels Ramipril, Enalapril, Lisinopril, Perindopril Dry cough, Low blood pressure, Kidney problems
ARB’s (Angiotensin receptor blockers) Relaxes blood vessels and reduces blood pressure (similar to ACE) Candesartan, Losartan, Valsartan Low blood pressure, high potassium levels
Beta Blockers Slow the heart rate, protects against effects of adrenaline and noradrenaline (fight/flight responses) Bisoprolol, Carvedilol, Nebivolol Dizziness, tiredness, blurred vision.
Mineralocorticoid Receptor Antagonists (MRA’s) Increase urine output, lowers blood pressure, reduces fluid around the heart Spironolactone, Eplerenone Enlarged breasts, tender breasts, increased hair growth, sleeping difficulties, dizziness, headaches.

Increases potassium level (dangerously high)

Diuretics Increase urine output, relieves ankle swelling and breathlessness Furosemide, Bumetanide Dehydration, reduced levels of sodium and potassium in blood.
Ivabradine Slows heart rate Corlanor Headaches, dizziness and blurred vision.
Sacubitril/valsartan (combination Neprilysin(enzyme) Inhibitor and ARB) Relaxes blood vessels Sacubitril, Valsartan Low blood pressure, high potassium levels and kidney problems
Hydralazine with nitrate Relaxes and opens up blood vessels (prescribed instead of ACE or ARB) Apresoline Headaches, fast heartbeat, pounding, fluttering, irregular heartbeat.
Digoxin Strengthens heart muscle, strengthens heartbeat and more regular rhythm Lanoxin Dizziness, blurred vision, nausea and vomiting, diarrhoea and irregular heartbeat

 

Upon diagnosis of Heart failure, it would be the intention of the Doctor to reduce the amount of stress on the heart and to make the patient more comfortable.   They would be looking at managing a combination of factors including the patients blood pressure, thickness of the blood, fluid retention, cholesterol levels, stress and the action/reaction of heart.   So immediately any patient is likely to be prescribed an ACE Inhibitor or an ARB to lower blood pressure along with a statin for cholesterol reduction and probably Aspirin for thinning the blood.  Other common blood thinning medications are Warfarin and Heparin.

As shown in Table 3, the side effects of taking drugs are at best uncomfortable and have an effect on a patient’s quality of life and at worst are dangerous, therefore, additional medications maybe required to counterbalance these effects.  In some cases, the side effects are worse for the patient than the initial presenting complaint/symptoms, particularly in cases of mild heart failure, the patient will undoubtedly find this distressing, and this is perhaps where homeopathy can begin to help.  Certainly we have remedies at our fingertips that will relieve many of the symptoms of many different heart disorders, Table 4 shows some of the Heart specific remedies, using these with accurate Constitutional prescribing could reduce the patients symptoms dramatically and in fact, could eliminate the need for the use of some Allopathic medicine.

Table 4: Homeopathic Remedies for Heart Conditions
Remedy Symptom Picture Modalities
AURUM– Gold Angina, fatty degeneration. Hypertrophy, Inflammation of endocardium, Constriction, Oppression, Pain of heart. Atherosclerosis. Sense of hopelessness. <Evening, <Cold, <Lying

>Walking slowly, >Warmth

DIGITALIS PURPUREA – Foxglove Palpitations-violent, Heart murmur, Oedema of pericardium, dilation of the myocardium, Pulse issues/variation esp. SLOW. Faintness with slow pulse, Blueness. Prostate and Liver complaints. <Anxiety, <Exertion, <Motion, <Becoming heated, <Sitting bent forward
CACTUS GRANDIFLORA –

Night Blooming Cereus

Constriction of heart, throat, chest. Angina, Hypertrophy, Heart Murmurs,

Oppressive/constrictive pains of the heart, Palpitations.  Congestion of the chest, Rattling respiration.

(Constriction on emotional level)

<Slight exertion, <Lying on left side,
CRATAEGUS OXYACABTHA – Hawthorn Berry Chronic heart conditions with Weakness, Very feeble and irregular heart action, Nervous palpitation, tumultuous, violent and irregular heart action. Pulse is frequent intermittent, irregular and weak.  Oedema.  Pain in chest, Breathing difficulties, Dizziness, Heart valve complaints, Atherosclerosis of the coronary arteries. <Motion, <Warm room, <Walking

>Open air, >Rest

LATRODECTUS MACTANS – The Black Widow Spider ANGINA PECTORIS (specific).  Heart pains, weakness, Constriction, Cramped, Tension. Cardiac pain violent, sharp, Pain extending to left arm, Pulse thready, weak, fluttering.  Restlessness. <Motion,
ADONIS VERNALIS – Pheasant’s Eye Pericarditis, Myocarditis, Endocarditis, Mitral and Aortic regurgitation, Cardiac Asthma, Chronic aortitis. (Medium/grave Pathology of the heart) Heart problems after kidney disease. Hyperthyroidism and tachycardia. Swelling of extremities in morning on waking.  Fatty degeneration of heart. < Rest

>Slow motion, >Walking in open air

LYCOPUS VIRGINICUS – Bugle Weed Early stages of heart failure. Functional Disease of Heart, Cardiac irritability.  Aneurism of large vessels near the heart.  Constricted pain and tenderness of heart, Rapid pulse, tumultuous cardiac action, wandering pains and wandering mind. Hyperthyroidism, goitre. Pulmonary complaints. Varicose veins esp. lower limbs.  Slightly irregular pulse. Patient is pale, restless. < After exertion (difficult breathing and palpitations)

<turning over on right side

Dislike of any food

NAJA NAJA – Indian Cobra Organic Heart Disease. (Structural damage after Heart Attack) Hypertrophy and valvular issues.  Damage to heart after infections.  Weakness of heart.  Angina pectoris. Severe stitching pain in heart region shooting to left scapula. Cardiac cough. Choking throat. Dyspnoea (like a fish out of water). Palpitations. Constriction, being squeezed, trapped.  No space for the heart Must hold hand over chest

<Tight collars, <Lying on left side

KALMIA LATIFLOLIA – Mountain Laurel Nerves, Heart, Circulation. Palpitation and pain. Visible palpitations, loud murmur.  Angina Pectoris pain extending to left hand.  Stitching pains in heart – take breath away.  Slow pulse. Inflammation of endocardium (rheumatic). Rheumatism, Eye pain, Neuralgic pain. <Lying on left side

>Lying on back

 

 

Homeopathy and Chronic Heart Failure

Homeopathy can certainly play a useful role, not only in preventative cardiac care, but also a supportive (adjuvant) method of treatment, when used in conjunction with conventional medicine.  Homeopathic treatment should be approached with caution as Heart failure is serious.  I am feeling that I would approach a patient’s Cardiac care very much in a supportive manner and with no promise of stopping any Conventionally prescribed medication.  If as a result of carefully chosen remedies the patient’s Cardiologists suggests reducing or stopping medication that would be an incredible bonus but should always be at the suggestion/recommendation of the Specialist.

As previously stated, there are many remedies with Heart symptoms but below, I have chosen 3 remedies to consider should the presenting symptoms concur.

In the case of Angina Pectoris, (tight chest pain associated with underlying myocardial ischaemia), conventional treatment would include, but not be limited to, a Beta blocker to slow the heart rate, an Aspirin or Anti Platelet medication to thin the blood reducing the risk of clots, and most certainly a Nitrate spray to be used when an attack occurs, usually upon exertion.    The symptoms of angina are covered by a few remedies, and as always individual symptoms should be used to differentiate, however,  LATRODECTUS MACTANS  is considered to be almost specific for Angina Pectoris and has the Cramping, Constriction, Violent cardiac pain and worse Motion which fits the symptom picture of this condition.

The remedy ADONIS VERNALIS can be used in the treatment of Pericarditis, Myocarditis, Endocarditis, Mitral and Aortic valve regurgitation and Chronic Aortitis.  All of these are serious issues and are Medium /grave pathology of the heart.  Using homeopathy in any of these conditions should be in conjunction with Conventional medicine and used as a supportive therapy.   This remedy works on regulating the heartbeat and can be used to address Low Blood pressure, which could be as a result of Conventional medication.  It is also a strong diuretic so can be used to counter any water retention which is present due to poor circulatory function.  This dual function could result in the patient perhaps reducing allopathic medication and having to take maybe one less tablet.

Patients presenting with Heart symptomology as well as rheumatism, in particular, Rheumatoid Arthritis could be treated with KALMIA LATIFLOLIA.  This remedy has an affinity with HEART, Circulation and joints and whilst Rheumatism is a complaint affecting the joints, it can have an effect on the heart too.  It is reported that Rheumatoid Arthritis sufferers have a significantly higher risk (40-50%) of heart failure.  The research I found was unclear as to why this is the case, but mention was made of the inflammatory aspect of Rheumatoid Arthritis along with side effects of its medication. The patient will be worse for motion and worse for physical exertion, may experience palpitations, with a slow small pulse and oedema of the feet, legs, abdomen.  Patient is better for Lying on back.

 

Clearly homeopathy cannot be used in extremely life-threatening conditions like heart attack or stroke, but it can play a complementary role leading to effective control of hypertension and other cardiac concerns.  Together with the appropriate lifestyle changes it can give a patient symptomatic relief whilst helping with the emotional aspects of being diagnosed with a chronic condition.

 

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