| | | | Other Names | | | Heart Failure, CHF, Congestive Cardiac Failure, CCF.
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| | | Congestive heart failure (CHF) is a chronic condition that results when
the heart muscle is unable to pump blood as efficiently as is needed. High
blood pressure can cause congestive heart failure. Failure of the heart
pump can also result from many other causes, such as severe anemia,
hyperthyroidism, heart attacks, and arrhythmias of the
heart.
Caution: Congestive heart failure is a serious medical
condition that requires expert management rather than
self-treatment.
What are the symptoms of congestive heart failure?
CHF leads to breathlessness, fatigue, and accumulation of fluid in the
lungs or the veins (primarily in the legs) or both.
Conventional
treatment options: Drug treatments in CHF are often directed at improving
the effectiveness of the heart's contractions. Diuretics may improve
function of the heart's ventricles (muscular pumping chambers). Loop
diuretics are often used and include furosemide (Lasix), chlorothiazide
(Diuril), bumetanide (Bumexr), and metolazone (Mykrox, Zaroxolynr). ACE
inhibitors also improve heart and blood vessel function as well as
exercise tolerance. They include captopril (Capoten), enalapril
(Vasotec), lisinopril (Prinivil, Zestril), and quinapril (Accupril).
Digitalis preparations, most commonly digoxin (Lanoxin), may be used to
improve heart function and reduce the amount of diuretics needed. Drugs
may also be used to regulate the heart's rhythm.
Lifestyle changes
that may be helpful: Even with severe disease, appropriate exercise can
benefit those with CHF.1 2 In a controlled trial, long-term (one year)
exercise training led to improvements in quality of life and functional
capacity in people with CHF.3 Nonetheless, too much exercise can be
life-threatening for those with CHF. How much is "too much" varies from
person to person; therefore, any exercise program undertaken by someone
with CHF requires professional supervision.
Non-steroidal
anti-inflammatory drugs (NSAIDs) appear to significantly increase the risk
of CHF. The use of NSAIDs in one preliminary study was found to double the
likelihood of hospital admission with CHF the following week. This
likelihood increased by more than 10 times for patients with a history of
heart disease.4 This study did not include people taking low-dose
aspirin.
Nutritional supplements that may be helpful: People with
CHF have insufficient oxygenation of the heart, which can damage the heart
muscle. Such damage may be reduced by taking L-carnitine supplements.5
L-carnitine is a natural substance made from the amino acids, lysine and
methionine. Levels of L-carnitine are low in people with CHF;6 therefore,
many doctors recommend that those with CHF take 500 mg of L-carnitine two
to three times per day.
Most L-carnitine/CHF research has used a
modified form of the supplement called propionyl-L-carnitine (PC). In one
double-blind trial, people using 500 mg of PC per day had a 26% increase
in exercise capacity after six months.7 In double-blind research, other
indices of heart function have also improved after taking 1 gram of PC
twice per day.8 It remains unclear whether propionyl-L-carnitine has
unique advantages over L-carnitine, as limited research in animals and
humans has also shown very promising effects of the more common
L-carnitine.9
Magnesium deficiency frequently occurs in people with
CHF, and such a deficiency may lead to heart arrhythmias. Magnesium
supplements have reduced the risk of these arrhythmias.10 People with CHF
are often given drugs that deplete both magnesium and potassium; a
deficiency of either of these minerals may lead to an arrhythmia.11 Many
doctors suggest magnesium supplements of 300 mg per day.
Whole
fruit and fruit and vegetable juice, which are high in potassium, are also
recommended by some doctors; however, this dietary change should be
discussed with a healthcare provider, because several drugs given to
people with CHF may actually cause retention of potassium, making dietary
potassium, even from fruit, dangerous.
Taurine, an amino acid,
helps increase the force and effectiveness of heart-muscle contractions.
Research (some double-blind) has shown that taurine helps people with
CHF.12 13 14 15 Most doctors suggest taking 2 grams three times per
day.
As is true for several other heart conditions, coenzyme Q10
(CoQ10) has been reported to help people with CHF,16 sometimes
dramatically.17 Positive effects have been confirmed in double-blind
research18 and in an overall analysis of eight controlled trials.19
However, some double-blind trials have reported modest20 or no
improvement21 22 23 in exercise capacity or overall quality of life. Most
CoQ10 research used 90 to 200 mg per day. The beneficial effects of CoQ10
may not be seen until after several months of treatment. Discontinuation
of CoQ10 supplementation in people with CHF has resulted in severe
relapses and should only be attempted under the supervision of a
doctor.24
The body needs arginine, another amino acid, to make
nitric oxide, which increases blood flow. This process is impaired in
people with CHF. Arginine supplementation (5.6 to 12.6 grams per day) has
been used successfully in double-blind trials to treat CHF.25 A
double-blind trial has also found that arginine supplementation (5 grams
three times daily) improves kidney function in people with
CHF.26
For people with congestive heart failure, intravenous
injections of creatine have been found to improve heart function; oral
supplementation has not been effective, though it does improve skeletal
muscle function.27 28
In a preliminary study, blood levels of DHEA
(dehydroepiandrosterone) were found to be lower in people with CHF than in
people without the disease. The lowered blood levels of DHEA among these
people was proportional to the severity of their disease.29 However, there
is no evidence that DHEA supplementation can prevent or reverse
CHF.
Are there any side effects or interactions? Refer to the
individual supplement for information about any side effects or
interactions.
Herbs that may be helpful: Clinical trials have shown
that standardized extracts made from the leaves and flowers of hawthorn
are effective in helping people with early-stage CHF.30 31 Hawthorn
extracts appear to increase blood flow to the heart, increase the strength
of heart contractions, reduce resistance to blood flow in the extremities,
and act as an antioxidant.32 33 34 In a large preliminary trial, people
with mild to moderate CHF were given 300 mg of hawthorn flower and leaf
extract (standardized to contain 2.2% flavonoids) three times a day for
two months.35 Symptoms of CHF-including heart palpitations, chest
pressure, and swelling in the extremities-decreased throughout the trial
during the use of hawthorn.
Hawthorn extracts are available in
capsules or tablets standardized to either total flavonoid content
(usually 2.2%) or oligomeric procyanidins (usually 18.75%). Doctors who
work with herbal medicine often suggest 80 to 300 mg two to three times
per day. Hawthorn berry products that are not standardized may be weaker,
and the recommended amount is typically 4 to 6 grams per day for the whole
herb, or 4 to 5 ml of the tincture three times per day.
Coleus
contains forskolin, a substance that may help dilate blood vessels and
improve the forcefulness with which the heart pumps blood.36 Recent
clinical trials indicate that forskolin improves heart function in people
with congestive heart failure and cardiomyopathy.37 38 A preliminary trial
found that forskolin reduced blood pressure and improved heart function in
people with cardiomyopathy. These trials have used intravenous infusions
of isolated forskolin. It is unknown whether oral coleus extracts would
have the same effect. While many doctors expert in herbal medicine would
recommend 200 to 600 mg per day of a coleus extract containing 10%
forskolin, these amounts are extrapolations and have yet to be confirmed
by direct clinical research.
A small clinical trial found that
supplementation with a bark extract of Arjun (Terminalia arjuna) improved
heart function as well as lung congestion in patients with severe CHF.39
Patients in the study took 500 mg of Arjun extract three times per day and
began to exhibit significant improvement in heart function within two
weeks; improvement continued over the course of approximately two years.
The herb extract used in this study was concentrated but not standardized
for any particular constituent. Commercial preparations are sometimes
standardized to contain 1% arjunolic acid. Larger clinical trials are
needed to confirm the results of this small study.
Are there any
side effects or interactions? Refer to the individual herb for information
about any side effects or
interactions.
References:
1. Coats AJS. Effects of
physical training in chronic heart failure. Lancet
1990;335:63-6.
2. Oka RK, De Marco T, Haskell WL, et al. Impact of
a home-based walking and resistance training program on quality of life in
patients with heart failure. Am J Cardiol 2000;85:365-9.
3.
Belardinelli R, Georgiou D, Cianci G, Purcaro A. Randomized, controlled
trial of long-term moderate exercise training in chronic heart failure.
Circulation 1999;99:1173-82.
4. Page J, Henry D. Consumption of
NSAIDs and the development of congestive heart failure in elderly
patients. Arch Intern Med 2000;160:777-84.
5. Bartels GL, Remme WJ,
Pillay M, et al. Effects of L-propionylcarnitine on ischemia-induced
myocardial dysfunction in men with angina pectoris. Am J Cardiol
1994;74:125-30.
6. Suzuki Y, Masumura Y, Kobayashi A, et al.
Myocardial carnitine deficiency in chronic heart failure. Lancet
1982;i:116 (letter).
7. Mancini M, Rengo F, Lingetti M, et al.
Controlled study on the therapeutic efficacy of propionyl-L-carnitine in
patients with congestive heart failure. Arzneimittelforschung
1992;42:1101-4.
8. Pucciarelli G, Mastursi M, Latte S, et al. The
clinical and hemodynamic effects of propionyl-L-carnitine in the treatment
of congestive heart failure. Clin Ther 1992;141:379-84.
9.
Kobayashi A, Masumura Y, Yamazaki N. L-carnitine treatment for congestive
heart failure-experimental and clinical study. Jpn Circ J
1992;56:86-94.
10. Bashir Y, Sneddon JF, Staunton A, et al. Effects
of long-term oral magnesium chloride replacement in congestive heart
failure secondary to coronary artery disease. Am J Cardiol
1993;72:1156-62.
11. Packer M, Gottlieb SS, Kessler PD.
Hormone-electrolyte interactions in the pathogenesis of lethal cardiac
arrhythmias in patients with congestive heart failure. Am J Med 1986;80
(Suppl 4A):23-9.
12. Azuma J, Sawamura A, Awata N, et al.
Double-blind randomized crossover trial of taurine in congestive heart
failure. Curr Ther Res 1983;34(4):543-57.
13. Azuma J, Hasegawa H,
Sawamura N, et al. Taurine for treatment of congestive heart failure. Int
J Cardiol 1982;2:303-4.
14. Azuma J, Hasegawa H, Sawamura A, et al.
Therapy of congestive heart failure with orally administered taurine. Clin
Ther 1983;5(4):398-408.
15. Azuma J, Takihara K, Awata N, et al.
Taurine and failing heart: experimental and clinical aspects. Prog Clin
Biol Res 1985;179:195-213.
16. Mortensen SA, Vadhanavikit S,
Baandrup U, Folkers K. Long-term coenzyme Q10 therapy: a major advance in
the management of resistant myocardial failure. Drug Exptl Clin Res
1985;11:581-93.
17. Folkers K, Langsjoen P, Langsjoen PH. Therapy
with coenzyme Q10 of patients in heart failure who are eligible or
ineligible for a transplant. Biochem Biophys Res Commun
1992;15:247-53.
18. Morisco C, Trimarco B, Condorelli M. Effect of
coenzyme Q10 in patients with congestive heart failure: a long-term
multicenter randomized study. Clin Invest 1993;71:S134-6.
19. Soja
AM, Mortensen SA. Treatment of chornic cardiac insufficiency with coenzyme
Q10, results of meta-analysis in controlled clinical trials. Ugeskr Laeger
1997;159:7302-8.
20. Hofman-Bang C, Rehnqvist N, Swedberg K, et al.
Coenzyme Q10 as an adjunctive in the treatment of chronic congestive heart
failure. The Q10 Study Group. J Card Fail 1995;1:101-7.
21.
Permanetter B, Rossy W, Klein G, et al. Ubiquinone (coenzyme Q10) in the
long-term treatment of idiopathic dilated cardiomyopathy. Eur Heart J
1992;13:1528-33.
22. Watson PS, Scalia GM, Galbraith A, et al. Lack
of effect of coenzyme Q on left ventricular function in patients with
congestive heart failure. J Am Coll Cardiol 1999;33:1549-52.
23.
Khatta M, Alexander BS, Krichten CM, et al. The effect of coenzyme Q10 in
patients with congestive heart failure. Ann Intern Med
2000;132:636-40.
24. Mortensen SA, Vadhanavikit S, Baandrup U,
Folkers K. Long-term coenzyme Q10 therapy: a major advance in the
management of resistant myocardial failure. Drug Exptl Clin Res
1985;11:581-93.
25. Rector TS, Bank A, Mullen KA, et al.
Randomized, double-blind, placebo controlled study of supplemental oral
L-arginine in patients with heart failure. Circulation
1996;93:2135-41.
26. Watanabe G, Tomiyama H, Doba N. Effects of
oral administration of L-arginine on renal function in patients with heart
failure. J Hypertens 2000;18:229-34.
27. Andrews R, Greenhaff P,
Curtis S, et al. The effect of dietary creatine supplementation on
skeletal muscle metabolism in congestive heart failure. Eur Heart J
1998;19:617-22.
28. Gordon A, Hultman E, Kaijser L, et al. Creatine
supplementation in chronic heart failure increases skeletal muscle
creatine phosphate and muscle performance. Cardiovasc Res
1995;30:413-8.
29. Moriyama Y, Yasue H, Yoshimura M, et al. The
plasma levels of dehydroepiandrosterone sulfate are decreased in patients
with chronic heart failure in proportion to the severity. J Clin
Endocrinol Metab 2000;85:1834-40.
30. Leuchtgens H. Crataegus
special extract (WS 1442) in cardiac insufficiency. Fortschr Med
1993;111:352-4.
31. Schmidt U, Kuhn U, Ploch M, Hbner WD. Efficacy
of the hawthorn (Crataegus) preparation LI 132 in 78 patients with chronic
congestive heart failure defined as NYHA functional class II. Phytomed
1994;1:17-24.
32. Maevers VW, Hensel H. Changes in local myocardial
blood flow following oral administration of a Crataegus extract to
non-anesthetized dogs. Arzneimittelforschung 1974;24:783-5.
33.
Weikl A, Noh HS. The influence of Crataegus on global cardiac
insufficiency. Herz Gerfsse 1992; 11:516-24.
34. Bahorun T, Trotin
F, Pommery J, et al. Antioxidant activities of Crataegus monogyna
extracts. Planta Med 1994; 60:323-8.
35. Schmidt U, Albrecht H,
Podzuweit M, et al. High-dose crataegus therapy in patients suffering from
congestive heart failure NYHA class I and II. Z Phytotherapie
1998;19:22-30.
36. Lindner E, Dohadwalla AN, Bhattacharya BK.
Positive inotropic and blood pressure lowering activity of a diterpene
derivative isolated from Coleus forskohli: Forskolin.
Arzneimittelforschung. 1978;28:284-9.
37. Baumann G, Felix S,
Sattelberger U, Klein G. Cardiovascular effects of forskolin (HL 362) in
patients with idiopathic congestive cardiomyopathy-a comparative study
with dobutamine and sodium nitroprusside. J Cardiovasc Pharmacol
1990;16:93-100.
38. Kramer W, Thormann J, Kindler M, Schlepper M.
Effects of forskolin on left ventricular function in dilated
cardiomyopathy. Arzneimittelforschung 1987;37:364-7.
39. Bharani A,
Ganguly A, Bhargava KD. Salutary effect of Terminalia Arjuna in patients
with severe refractory heart failure. Int J Cardiol
1995;49:191-9.
Source: NOW Foods
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Please Note: This Traditional Use information is provided as a courtesy only. The products indicated above may be listed in error. This information is based on Traditional and Folklore Medicine which uses natural materials to support health. This information has not been evaluated or approved by the FDA and is not based on scientific evidence from any source. These statements have not been evaluated by the Food and Drug Administration (FDA). These products are intended to support general well being and are not intended to treat, diagnose, mitigate, prevent, or cure any condition or disease. If conditions persist, please seek advice from your medical doctor.
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Congestive Heart Failure - Health - Dual Head Stethoscope - Black Tubing
12.96 US
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Congestive Heart Failure - Health - Sprague Rappaport Type Stethoscope - Single Head - Black
25.40 US
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Congestive Heart Failure - Health - Dual Head Stethoscope - Navy Tubing
12.96 US
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Congestive Heart Failure - Health - Sprague Rappaport Type Stethoscope - Single Head - Dark Blue Tubing
25.40 US
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Congestive Heart Failure - Health - Sprague Rappaport Type Stethoscope - Single Head - Purple Tubing
25.40 US
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Congestive Heart Failure - Health - Sprague Rappaport Type Stethoscope - Hunter Green Tubing
25.40 US
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