Congestive Heart Failure

Congestive heart failure (CHF) is the process that occurs when the heart does not pump blood effectively. Congestion then follows in the lungs and peripheral tissues. CHF can occur in both ventricles or just on one side, although it will often progress to both sides. The symptoms include breathlessness and difficulty breathing, usually made worse by lying down ^[1]. CHF is often accompanied with fatigue, swelling, and sometimes chest pain. A longstanding history of high blood pressure is a significant risk factor. To be diagnosed, your doctor may perform a physical exam and run blood tests, as well as use other testing methods like a echocardiograph. The pro-BNP test is a blood test that can be used to figure out if shortness of breath is caused by the lungs or by the heart. If elevated, pro-BNP indicates more of a cardiovascular cause. In terms of conventional treatments for CHF, the treatments depend on the stage and progression of the condition. It is usually categorized in 4 stages (from those with the lowest risk of heart failure to those with the highest risk of heart failure). Based on the New York Heart Association (NYHA) Functional Classification, the tables below indicate how patients would be categorized.

Class     Patient Symptoms

1. No limitation of physical activity. Ordinary physical activity does not cause undue fatigue, palpitation, dyspnea (shortness of breath).
2. Slight limitation of physical activity. Comfortable at rest. Ordinary physical activity results in fatigue, palpitation, dyspnea (shortness of breath).
3. Marked limitation of physical activity. Comfortable at rest. Less than ordinary activity causes fatigue, palpitation, or dyspnea.
4. Unable to carry on any physical activity without discomfort. Symptoms of heart failure at rest. If any physical activity is undertaken, discomfort increases.

Class     Objective Assessment

1. No objective evidence of cardiovascular disease. No symptoms and no limitation in ordinary physical activity.
2. Objective evidence of minimal cardiovascular disease. Mild symptoms and slight limitation during ordinary activity. Comfortable at rest.
3. Objective evidence of moderately severe cardiovascular disease. Marked limitation in activity due to symptoms, even during less-than-ordinary activity. Comfortable only at rest.
4. Objective evidence of severe cardiovascular disease. Severe limitations. Experiences symptoms even while at rest.

Source: American Heart Association ^[2]

Conventional Treatments

Those who are at lower risk are advised to exercise regularly, quit smoking/drinking/illicit drug use, and to manage other risk factors. Specifically, metabolic risk factors should be controlled. Lipid disorders should be treated, high blood pressure should be managed, blood sugar should be checked, and if overweight or obese, weight loss should be implemented. Various drugs might be used for these purposes, including ACE inhibitors, beta blockers, and others. If things are on the more serious end, surgery options may be presented for coronary artery repair and valve repair or replacement. CHF is not a condition that appears suddenly. It is a condition that develops slowly over time due to a number of different causes. For example, volume overload could be caused by hyperthyroidism or anemia. Muscle loss could be caused by heart attack or a connective tissue disease. Underlying cardiovascular abnormalities or problems could also cause damage over time and increase the risk of CHF. That's why taking a preventive approach and managing one's risk factors become so important. That being said, there are many natural approaches (diet and lifestyle), as well as supplements that can be beneficial.

Diet and Lifestyle Suggestions

From a dietary perspective, there are multiple strategies that can be effective. Sodium restriction is usually first on the list. Restricting sodium (or salt) can be helpful because sodium retention occurs in CHF, which leads to losses of potassium and magnesium ^[3]. The depletion of these minerals can result in high sodium levels in cells. The recommendation is to limit dietary sodium to 3 grams per day, or even as low as 2 grams per day. Other dietary recommendations include lowering saturated fat intake (and avoiding trans-fats, always). Increasing the intake of fiber-rich foods and garlic, onions, and celery can also all have positive impacts on the cardiovascular system and in managing healthy blood flow. As mentioned above, the advice to exercise regularly is good at all stages of CHF, even in the preventive stages. The amount and intensity of exercise should be adjusted to age, fitness, and disease progression. In general, a combination of aerobic and resistance training is helpful. You should be careful not to exercise to the point of pain or injury, but just to the point of tolerance. Developing an ongoing habit is key.

Supplements

Co-Enzyme Q10

CoQ10 is used in the generation of energy within cells. The heart depends on an adequate supply for proper functioning. There are studies that show that doses of CoQ-10 (at least 100mg per day), show an improvement in a number of cardiovascular parameters. It increases left ventricular ejection fraction and survival rates, helps with signs and symptoms, reduces hospitlizations, and improves exercise tolerance ^[4]. CoQ10 also acts as an antioxidant and has been studied for multiple other health conditions.

Omega-3 Fatty Acids

Fish oil or omega-3 fatty acids are often recommended. They contain ingredients called EPA and DHA. Fish oil helps the heart by decreasing vascular resistance, reducing heart rate, and improving cardiovascular tests. There are some conflicting studies available on fish oil, but their safety profile is very well established. From a risk-benefit analysis, fish oil is a no brainer. Low levels of omega-3 fatty acids are associated with reduced survival and worsening cardiovascular outcomes. Fish oil is an excellent anti-inflammatory and can decrease cytokine production ^[5]. However, obtaining the correct minimum dose through diet can be risky in itself because of the bioaccumulation of heavy metals. A clean, pure, fish oil supplement that offers at least a dose of 1 gram of combined EPA and DHA is the usual recommendation.

Vitamin D

Vitamin D-3 or cholecalciferol has promising research showing that it is a beneficial supplement for treating CHF. Patients with CHF usually have lower amounts of vitamin D as compared to control groups. It has been shown that lower vitamin D levels are also associated with poorer outcomes and reduced survival ^[6]. In addition, lower vitamin D status is associated with higher amounts of cytokines and inflammation, which can further worsen CHF. Thus, at the very least ensuring that you are not vitamin D deficient would be a reasonable approach. Most practitioners recommend ongoing continual supplementation with vitamin D because even having moderate to high levels in this population may provide further benefit. If vitamin D deficient, start with a higher dose for a short duration to replenish stores. The ongoing dose could be as high as 5000IU daily, or above 1000IU depending on sun exposure habits.

Conclusion

Complications of CHF can be unexpected. It is important to manage all metabolic risk factors, including blood pressure, cholesterol, weight, and blood sugar. Exercise is of utmost importance at all stages of CHF and should be recommended on a regular basis and to tolerance. There are multiple dietary recommendations that are effective and beneficial for CHF, most notably sodium restriction. There are many nutritional supplements that have been researched to reduce the negative outcomes associated with CHF, including some that we touched on here like CoQ10, fish oil, and vitamin D. These are only examples; there exist many more supplements available. At any given time, we always recommend checking with your Naturopathic Doctor before beginning any supplement regimen. Every individual case is different and it is important to make sure there are no drug interactions and that the doses being used are appropriate for you.