Congestive Heart Failure

Congestive heart failure (CHF) occurs when the heart cannot pump out enough blood to meet the needs of the body. Any form of heart disease may lead to CHF, which results in a reduced ability to exercise and in severe cases can impair daily function. CHF is the most common cause of death for people over age 65.

Signs and Symptoms

• Shortness of breath
• Fatigue, exercise intolerance
• Rust-colored sputum
• Distended neck veins
• Cough—especially when waking
• Excessive nighttime urination
• Excessive protein in the urine
• Insomnia
• Nausea, vomiting
• Anorexia
• Anxiety
• Swelling in the extremities

What Causes It?

CHF can be the result of any type of heart disease or condition. The following factors make it more likely that you will get CHF.

• Smoking
• High-fat diet, excess body weight
• Alcohol abuse
• High sodium intake
• Influenza, pneumonia
• Noncompliance with prescribed medications or recommended diet

What to Expect at Your Provider's Office

Your health care provider will focus on identifying the cause and precipitating factors for CHF. Procedures include blood tests and electrocardiograms (ECG). Surgery may be needed if you have severe CHF.

Treatment Options

Drug Therapies

• Vasodilators—reduce narrowing of vessels; cornerstone of treatment; for example, angiotensin-converting enzyme (ACE) inhibitors; side effects include kidney failure, cough, low blood pressure
• Diuretics—main types of diuretics include thiazide, loop diuretics, and potassium-sparing diuretics
• Digitalis glycosides—increase the ability of the heart muscle to contract properly; prevent heart rhythm disturbances

Complementary and Alternative Therapies

Nutrition and herbal medicine can play an important role in increasing the strength of the heart without also increasing its workload.

Nutrition

• Antioxidants: vitamin C (1,000 mg three times a day), vitamin E (400 IU per day), selenium (200 mcg per day)
• Coenzyme Q10 (30 to 50 mg twice a day): antioxidant, increases oxygenation of tissue, including heart muscle
• Essential fatty acids (1,500 mg twice a day): anti-inflammatory
• Diet: garlic, ginger, and onions all have a beneficial effect on circulation. Increase fiber (especially water-soluble), fruits, vegetables, and vegetarian sources of protein. Increase potassium and decrease sodium in the diet.
• Homocysteine metabolism: Folic acid (800 mcg per day), B6 (50 mg per day), B12 (400 mg per day), betaine (200 to 1,000 mg per day)
• Magnesium (500 mg): mild vasodilation (dilates blood vessels)
• Taurine (500 mg twice a day): helps your heart work more efficiently
• Carnitine (750 to 1,500 mg twice a day): important in fatty acid metabolism, increases efficiency of cardiac function

Herbs

Herbs may be used as dried extracts (capsules, powders, teas), glycerites (glycerine extracts), or tinctures (alcohol extracts). Unless otherwise indicated, teas should be made with 1 tsp. of herb per cup of hot water. Steep covered 5 to 10 minutes for leaf or flowers, and 10 to 20 minutes for roots. Drink 2 to 4 cups per day.

• Hawthorn (Crataegus monogyna): increases blood vessel integrity; dose is 3 to 5 g. This dose is difficult to achieve in tea or tincture. Supplements or solid extract are used.
• Mistletoe (Viscum album): protects against high blood pressure and hardening of the arteries, historically for exhaustion and nervousness
• Linden (Tilia cordata): historically used to lower blood pressure
• Rosemary (Rosmarinus officinalis): increases coronary artery blood flow, used to stimulate digestion and relieve nervous tension
• Motherwort (Leonurus cardiaca): regulates heart rhythm
• Dandelion (Taraxacum officinale): potassium-sparing diuretic
• Indian tobacco (Lobelia inflata): helps reduce spasm, stimulates respiratory function, used in smoking cessation. May be toxic if used above recommended doses.
• Lily of the valley (Convallaria majalis): specific for cardiac insufficiency; exceeding recommended doses may lead to nausea, vomiting, headache, stupor. Use no more than 30 drops per day.
• Horsetail herb (Equisetum arvense): diuretic

Hawthorn should be included in any treatment. In addition, use a combination of four to six of the above herbs at 1 cup tea three times per day or 30 to 60 drops tincture three times per day.

Homeopathy
Homeopathy may be useful as a supportive therapy.

Physical Medicine
Castor oil pack. Apply oil directly to chest, cover with a clean soft cloth and plastic wrap. Place a heat source over the pack and let sit for 30 to 60 minutes. For best results use three consecutive days.

Contrast hydrotherapy. Alternate hot and cold applications to the chest. Alternate three minutes hot with one minute cold. Repeat three times to complete one set. Do two to three sets per day. For very sick patients, use cool and warm applications to decrease the contrast.

Acupuncture
May be helpful for increasing circulation and cardiac strength.

Massage
May help increase lymphatic drainage and reduce swelling.

Following Up

It is very important to prevent the heart disease from getting worse by getting plenty of exercise, eating a proper diet, and avoiding health risks.

Special Considerations

CHF is dangerous during pregnancy. The first two weeks after giving birth is particularly dangerous for women with CHF.

References

Atorvastatin. NMIHI. Accessed at http://www.nmihi.com/a/atorvastatin.html on March 22, 2018.

Bartram T. Encyclopedia of Herbal Medicine. Dorset, England: Grace Publishers; 1995:218-219.

Beta blockers. NMIHI. Accessed at http://drugs.nmihi.com/beta-blockers.htm on March 22, 2018.

Blumenthal M, ed. The Complete German Commission E Monographs: Therapeutic Guide to Herbal Medicines. Boston, Mass: Integrative Medicine Communications; 1998:120,142-144,162-163,171-172,197.

Brady JA, Rock CL, Horneffer MR. Thiamin status, diuretic medications, and the management of congestive heart failure. J Am Diet Assoc. 1995;95:541-544.

Cecil RL, Plum F, Bennett JC, eds. Cecil Textbook of Medicine. 20th ed. Philadelphia, Pa: WB Saunders Co; 1996.

Chronic Heart Failure. Ada Health. Accessed at https://ada.com/ on March 22, 2018.

Congenital heart defects. NMIHI. Accessed at http://www.nmihi.com/c/congenital-heart-defects.htm on March 22, 2018.

Furosemide. NMIHI. Accessed at http://www.nmihi.com/f/furosemide.html on March 22, 2018.

Gruenwald J, Brendler T, Jaenicke C, et al., eds. PDR for Herbal Medicines. Montvale, NJ: Medical Economics Co; 1998:779-781,932-923,1101-1103,1175-1176,1185-1187,1219-1221.

Heart Failure. MedlinePlus. Accessed at https://medlineplus.gov/ on March 22, 2018.

Murray MT. Encyclopedia of Nutritional Supplements. Rocklin, Calif: Prima Publishing; 1996:378-379.

Schmidt U, Kuhn U, Ploch M, Hubner WD. Efficacy of the hawthorn (Crataegus) preparation LI 132 in 78 patients with chronic congestive heart failure defined as NYHA functional class II. Phytomedicine. 1994;1:17-24.

Washington University School of Medicine, Department of Medicine. Washington Manual of Medical Therapeautics. 29th ed. Philadelphia, Pa: Lippincott-Raven Publishers; 1998.

Werback MR. Nutritional Influences on Illness. New Canaan, Conn: Keats Publishing, Inc; 1987:40-78,136-139,227-240.