Congestive Heart Failure

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

Treatment Plan

Treatment of CHF usually requires a combination of drugs. There are various mechanical devices that can also help. For example pacemakers help the heart to beat at a steady rate and intra-aortic balloons can provide increased blood flow to the heart. Oxygen relieves difficulty with breathing. Bed rest and reduced activity are important until your condition is stable. Surgery and heart transplant occur when other therapies for CHF fail.

Drug Therapies

Prescription

Vasodilators—reduce narrowing of vessels; cornerstone of treatment; for example angiotensin-converting enzyme (ACE) inhibitors; side effects include kidney failure cough hypotension
Diuretics—for fluid control and sodium retention; limiting dietary fluid and sodium (less than 2 g a day) reduces need for diuretics; main types of diuretics include thiazide loop diuretics and potassium-sparing diuretics; mechanical removal of fluid also may occur
Digitalis glycosides—increase the ability of the heart muscle to contract properly; prevent heart rhythm disturbances

Over the Counter

N/A

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 oxyacantha): 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 (Rosemariana officinalis): increases coronary artery blood flow used to stimulate digestion and relieve nervous tension
Mother wort (Leonorus cardiaca): regulates heart rhythm
Dandelion (Taraxacum officinalis): 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 and repeat three times. This is 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.

Supporting Research

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

Blumenthal M ed. The Complete German Commission E Monographs. 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; 1996.

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

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.

The publisher does not accept any responsibility for the accuracy of the information or the consequences arising from the application use or misuse of any of the information contained herein including any injury and/or damage to any person or property as a matter of product liability negligence or otherwise. No warranty expressed or implied is made in regard to the contents of this material. No claims or endorsements are made for any drugs or compounds currently marketed or in investigative use. This material is not intended as a guide to self-medication. The reader is advised to discuss the information provided here with a doctor pharmacist nurse or other authorized healthcare practitioner and to check product information (including package inserts) regarding dosage precautions warnings interactions and contraindications before administering any drug herb or supplement discussed herein.