Congestive Heart Failure

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Latest Edit: Hector 2013-12-02 (EDT)

Congestive heart failure (CHF) is a serious health concern. It describes a problem where the heart is functioning inadequately as a pump. This results in congestion in the lungs or backup pressure of blood in the veins which can result in shortness of breath and edema. Initially the symptoms may manifest only on exertion such as during exercise but often progress and occur even at rest.[1] CHF can present acutely in association with a myocardial infarction or atherosclerosis. Typically it is a chronic condition that develops over a number of years.

Congestive Heart Failure
Heart fitness.jpg

Congestive Heart Failure
Causes Dietary Factors, Smoking, Stress, Prescription Medications
See Also Cardiovascular Conditions, Hypertension, Atherosclerosis
Books Books on Cardiovascular Conditions
Articles Articles on Cardiovascular Conditions

Naturopathic Assessment

Article Heart Failure from AF, NDNR; 2013 February [1]

Causal Factors

In order to stimulate the innate ability of the body to heal the causes of disease must be identified and addressed. With congestive heart failure, the causes are variable and include lifestyle and environmental factors. CHF often develops as a result of other underlying cardiovascular conditions, hence the causes of conditions such as atherosclerosis and hypertension often are similar to those of CHF.

Lifestyle

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Article CoQ10 and Heart Failure , IHP ; Sept 2012
  • A diet high in sodium can predispose an individual to congestive heart failure.[2]

Social

  • Emotional excesses can increase the risk of cardiac decompensation and congestive heart failure.[3]

Environmental

  • Air Pollution
  • Air pollution in the form of particulate matter is associated with an increased risk of cardiac arrhythmia, exacerbates congestive heart failure, and can trigger acute myocardial infarction.[4]

Medical Interventions

  • Prescription Medications
  • A number of pharmaceutical medications are associated with increased risk of CHF including beta blockers, calcium channel blockers, glucocorticoids, NSAIDs, and vasodilatory drugs.[3]

Diagnostic Testing

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  • Physical Exam
  • The following findings on physical exam are often apparent in CHF:[5]
  • jugular venous distension
  • increased respiratory rate with accessory muscle use
  • pulmonary findings including rales, ronchi, and wheezing
  • liver enlargement
  • ascites
  • altered heart sounds
  • Blood tests can include:[5][6] Pro-BNP test and arterial blood gases. Blood tests to rule out other underlying cardiovascular conditions are commonly prescribed.
Chf.jpg
  • Other Diagnostic Tests
  • Other useful tests include:[5][6]
  • ECG or electrocardiogram, chest x-ray or radiograph, echocardiogram, sometimes a radionuclide multiple gated acquisition scan
  • Staging
  • Staging is an important aspect of the evaluation of CHF in order to properly direct treatment. In general, stages I and II of CHF are extremely responsive to treatment with natural therapies alone. The following are the criteria for the four stages of CHF:[2]
  • Stage I - Individual is symptom free at rest and with treatment
  • Stage II - Individual has impaired heart function with moderate physical effort, but has no symptoms at rest
  • Stage III - Individual has symptoms with minor physical exertion, but has no symptoms at rest
  • Stage IV - Symptoms are present at rest

Related Symptoms and Conditions

Conditions associated with congestive heart failure include:[7], [8]

Characteristics

  • CHF can be right sided, left sided, or both:[10]
  • Right ventricular failure is characterized by peripheral edema, jugular venous distension, hepatomegaly, cor pulmonale and ascites.
  • Left ventricular failure is characterized by the need to sleep sitting up (orthopnea), shortness of breath at night (dyspnea), and bilateral rales over the base of the lungs.

Common Questions asked in the assessment of CHF include:[5]

  • Any recent history of shortness-of-breath (dyspnea), cough or frothy sputum?
  • Any recent history of fatigue, lightheadedness or fainting?
  • Any unexplained weight gain?
  • Is there an ankle swelling or edema?
  • Is there any shortness of breath at night?
  • Is there any difficulty in breathing while lying down?
  • Is there any history of heart disease?
  • Although congestive heart failure is very rare in children if there is shortness of breath that is getting progressively worse or sweating above the lip and forehead especially during meals than CHF may need to be ruled out.[5]

Naturopathic Treatment

Article New Consideration of a Forgotten Treatment for Congestive Heart Failure, Vital Link; 2005 Fall

The goal of naturopathic treatment is to support and work in tandem with the healing power of the body and to address the causal factors of disease with individual treatment strategies. Congestive Heart Failure is considered a chronic disease. Addressing the underlying causes of CHF such as hypertension and obesity is often the therapeutic goal.[10] CHF can be extremely complex and difficult to manage, especially if Stage III or IV. If the CHF is advanced it is common and often advisable for patient to work concurrently with their naturopathic doctor and MD and/or cardiologist.[6], [10]

It is always advisable to work with a naturopathic doctor before engaging in any treatment plan.

Lifestyle

Lifestyle recommendations include:

  • Moderate exercise under the guidance of a health care professional is beneficial in improving fatigue levels in individuals with CHF. Exercise levels are recommended based on the severity of CHF. Programs may be as simple as begining with walking short distances and increase aerobic output over time. [14][10], [6]
  • Tai Qi, Yoga and Qi-Gong are beneficial forms of exercise in CHF.[11]
  • It is advisable to quit smoking immediately. Smoking reduces the supply of oxygen and is damaging to the heart and blood vessels.[15]
  • Positive Mental Outlook. Focus on fulfilling your heart's desire and finding the joy in your life.[16]

Naturopathic Therapies

The prescribing of naturopathic therapies requires the guidance of a naturopathic doctor as it depends on a number of factors including the causal factors, a person's age, prescription medications, other conditions and symptoms and overall health. It is always advisable to work with a naturopathic doctor prior to taking any natural therapies.

Naturopathic Therapies for congestive heart failure include:

  • Acupuncture can be beneficial in treating cardiovascular disorders.
  • Short cold baths can be beneficial as well as constitutional hydrotherapy with sine machine.[18]
  • Spinal manipulations of the upper thoracic can improve innervation to the heart and lungs.[18]
  • Many forms of bodywork are beneficial at promoting relaxation which is supportive treatment for CHF and other circulatory concerns.[18]

References

Reviewed by Iva Lloyd, BScH, RPE, ND [2]

  1. Berga S, Bowman M, Drossman D, Faling J, Frenkel E, Gabbard G et al. editors.(1992) The Merck Manual of Diagnosis and therapy 16th edition. Rathway: Merck & Co Inc.
  2. 2.0 2.1 Murray MT, Bongiorno PB (2006) Pizzorno Textbook of Natural Medicine 3rd ed Chap 160 Congestive Heart Failure Elsevier.
  3. 3.0 3.1 O'Brien JF, Falk JL (2009) Marx: Rosen's Emergency Medicine 7th ed Chap 79 Heart Failure Mosby
  4. Ueda K, Nitta H, Ono M (2009) Effects of fine particulate matter on daily mortality for specific heart diseases in Japan. Circ J;73(7):1248-54. PMID:19423947.
  5. 5.0 5.1 5.2 5.3 5.4 Dains J, Baumann L, Schibel P (2007) Advanced Health Assessment and Clinical Diagnosis in Primary Care, ed 3. Mosby Elsevier.
  6. 6.0 6.1 6.2 6.3 6.4 6.5 6.6 6.7 6.8 6.9 Prousky Johathan, Hoffer Abram (2008) Principles and Practices of Naturopathic Clinical Nutrition. CCNM Press
  7. Mulvihill, Selman, Holdaway, Tompary, Raymond editors (2006) Human Diseases – A Systemic Approach 6th ed. Pearson Education Inc.
  8. Dungan KM, Binkley P, Nagaraja HN, Schuster D, Osei K (2011) The effect of glycaemic control and glycaemic variability on mortality in patients hospitalized with congestive heart failure. Diabetes Metab Res Rev;27(1):85-93. PMID:21218512.
  9. Oreopoulos A, Ezekowitz JA, McAlister FA, Kalantar-Zadeh K, Fonarow GC, Norris CM, Johnson JA, Padwal RS (2010) Association between direct measures of body composition and prognostic factors in chronic heart failure. Mayo Clin Proc;85(7):609-17. PMID:20592169.
  10. 10.0 10.1 10.2 10.3 10.4 10.5 El-Hashemy Shehab (2007) Naturopathic Standards of Primary Care. CCNM Press Inc. Cite error: Invalid <ref> tag; name "Natprimary" defined multiple times with different content
  11. 11.0 11.1 11.2 11.3 11.4 11.5 11.6 Smith Fraser, Winterstein James (2008) An Introduction to Principles & Practices of Naturopathic Medicine CCNM Press Inc., Toronto:pg116-131
  12. 12.0 12.1 12.2 12.3 12.4 12.5 Pizzorno Joseph, Murray Micheal, Joiner-Bey Herb (2007) The Clinician's Handbook of Natural Medicine Churchill Livingstone
  13. 13.0 13.1 Rowland D(2000) Cardioprotective Nutrition A Critical Review of the Scientific Evidence. Report to The Heart and Stroke Foundation of Ontario. Rowland publications
  14. Wall HK (2010) Impact of home-based supervised exercise on congestive heart failure In J Cardiol;145(2);267-270
  15. Peters-Kimm F et al (2012) Determinants of heart failure self-care behaviour in community-based patients: a cross-sectional study Eur J Cardiovasc Nurs [April 18 2012 Epub ahead of print]
  16. tbr
  17. Hoffmann David (1992) Therapeutic herbalism: A correspondence course in phytotherapy
  18. 18.0 18.1 18.2 18.3 Boyle W, Saine A(1988). Lectures in Naturopathic Hydrotherapy. Eclectic Medical Publications. p159