By Stephen T. Sinatra, M.D., F.A.C.C., F.A.C.N., C.N.S., C.B.T.
*Q: My doctor has recommended that I get a pacemaker since I started having episodes of slow heart rate due to atrial fibrillation. I’m also on a number of drugs. Can you suggest any natural remedies?
Slow heart rates during atrial fibrillation (AF) may be due to a problem with the conduction system or the result of medications given to control the high heart rates of AF. Your physician may have recommended that you consider a pacemaker if your current slow heart rate is excessively low and/or your slow heart rate episodes are creating symptoms like extreme fatigue, lightheadedness or even passing out.
If my AF patients have an acceptable quality of life (no repeated symptoms of dizziness or loss of consciousness), a satisfactory exercise evaluation and monitored evidence of heart rate control, I try to avoid some of the more toxic drugs commonly prescribed to maintain an acceptable heart rate range (the actual range varies with the individual) by adding nutritional and herbal supplements to the treatment plan.
I am often able to successfully achieve “rate control” – getting the heart rate to an asymptomatic level with low doses of a beta-blocker in combination with the following:
- A potassium-rich diet of fruits, vegetables, sea vegetables, fish, lean meats and low-fat dairy products.
- Daily doses of magnesium (400 mg) and calcium (500 – 1,000 mg).
- Broad spectrum carnitine – 1 – 2 grams daily.
- D-ribose – 5 grams (1 teaspoon in juice) 2 to 3 times daily
- Hawthorne berry (500 mg, one to three times per day). Hawthorne berry can increase the action of digoxin (Lanoxin), so if you take any form of digoxin or digitalis, your physician must monitor your drug level when you take this herb.
- Coenzyme Q10 (the equivalent of 120 to 240 mg daily).
- Fish oil or squid oil 1 – 2 grams daily
Many of my patients do require a pacemaker or have ablation therapy if they swing between very low and very high heart rates, despite medication and the above recommendations. Ask your physician to help you with the guidelines I have outlined, and have your heart closely monitored while following my treatment plan.
*Q: I recently had bypass surgery. How long should I wait before I resume activities like sex?
That question is on most patients’ minds who have just had heart surgery. First, you can resume sexual relations anytime after surgery, but it’s important to lower your expectations. Remember that both you and your spouse have been through a stressful experience stemming from your coronary artery bypass surgery. It’s important for you and your partner to ease back into your sexual relationship (this also applies to patients who had recent heart attacks or angioplasty) and not expect too much from each other.
It’s also very critical for you to talk openly about your fears, expectations and, above all, any anxieties you may have about impotence or frigidity. Choose a time and place for a sexual encounter that is relaxed and familiar to you. Try positions that use minimal energy such as lying on your side. Avoid placing strain upon the chest muscles. If you’re a man, try lying on your back with your partner on top. If you’re a woman and your chest is sensitive, you may want to try a more upright position. I also caution my patients not to have sexual relations within one to two hours after eating since this may place any additional burden upon your heart. And by all means, avoid excessive consumption of alcohol.
*Q: I had bypass surgery seven months ago, but I still don’t feel like my “old self.” I’m so tired most of the time. Some of my friends, even people older than me, bounced right back after their bypasses. I don’t have any medical complications, and I’m not taking medications, so what’s wrong?
Your concern is not uncommon. In fact, a fellow cardiologist surprised me by reporting he didn’t feel like “his old self” for almost a year after his own open heart surgery. His year-long recovery, however, has changed the way he treats his patients and the way he lives his life for the better. My friend often muses that “life begins anew after heart surgery.”
For the first six months after heart surgery, fatigue is quite normal. Prolonged fatigue, however, may be a symptom of depression, which is also not uncommon after major surgery. Depression is associated with disrupted sleep patterns – middle of the night awakenings anytime between 2 a.m. and 4 a.m. is common – eating disturbances (overeating or lack of appetite), memory difficulty and an overall lack of interest or pleasure in activities. If you have some of these symptoms, ask your physician for guidance. A few visits to a counselor may be very helpful to you to explore the emotional impact and the symbolic meaning your heart surgery may have for you.
Your tiredness also could be the result of spending extra energy in evaluating your life and priorities following major, traumatic surgery. A comment made by a daughter of one of my patients made me ponder the emotional complications of life after open heart surgery. She remarked that her father’s heart had “been touched” by the surgeon and her dad claimed that his life has not been the same since. For him, the recovery process became a period of realizing his vulnerabilities, reevaluating his priorities and reassessing where he was in life. Remember, you too have had your heart “touched” by another human being in order to be healed. Are you aware of feeling more vulnerable and/or are you examining the quality or purpose of your life?
Don’t forget you may need more nutritional support and exercise to boost your energy level during this time. I also recommend that if you did not join a cardiac rehab program after surgery, now is a good time to do so, even for a short period.
*Q: I have a valvular condition called aortic stenosis. My doctors had recommended that I undergo valve replacement surgery. Please tell me what I can do to prevent this. I also suffer from congestive heart failure. At the moment, I puff heavily if I exert myself or rush to do something. Am I in danger?
As you may already know, aortic stenosis restricts movement of one or all of the flaps of the aortic valve. The aortic valve controls blood flow from the left ventricle out to the aorta. If the valve opening is constricted, there may be an intermittent back flow of blood to the lungs, resulting in chronic congestion due to the heart’s failure to keep blood consistently moving forward. Exertion often causes the symptom you describe, even in less severe cases. If you have aortic stenosis, there is probably as strong relationship between the stenotic valve and your congestive heart failure.
Yes, you are in danger of flash pulmonary edema, which can be fatal. In the mean time you need a metabolic cardiology approach as does anyone with any degree of AS, which depletes coenzyme Q10 because of the strain on the heart muscle cells to generate extra ATP.
I recommend my patients with AS take:
- Coenzyme Q10
- 100 mg once a day for first week;
- 100 mg twice a day for the second week;
- 100 mg three times a day for maintenance;
- D-ribose – 1 teaspoon (5 gms) three times daily in water or your favorite beverage;
- L-carnitine – 1000 mg two to three times per day on an empty stomach;
- Magnesium – 200 mg twice a day. If you have kidney problems, consult your physician.
Unfortunately, there is nothing short of valvular reconstruction or replacement surgery that will help when your condition becomes advanced enough to cause recurrent bouts of congestive heart failure. If your quality of life is unacceptable the way it is, and if you have an enlarged left ventricle with a tight aortic valve that restricts blood flow, you must have surgery to improve your condition. I recommend that 3 to 4 weeks before your surgery, you maintain a daily regimen of a multivitamin formula with coenzyme Q10 (the equivalent of 240-300 mg daily in divided dosages with food). This can help your heart maintain the strength it will need to come off heart-lung bypass and to reduce the risk of postoperative complications.
**Q: I’ve had a quadruple bypass. If I ever need another bypass surgery, could I try chelation instead?
Quadruple bypass surgery involves “bypassing,” or re-routing, (via a segment from a healthy artery elsewhere in the body) the blood around the arteries leading to the heart to improve the flow of blood and oxygen. As this is a major invasive surgery, many people don’t want to go through it and seek alternative options. Problem is, by the time a person is in a position to need quadruple bypass surgery (as opposed to regular bypass surgery), all four coronary arteries are usually pretty clogged, meaning that coronary artery disease (CAD or CVD, cardiovascular disease) is severe.
Some people, amazingly, have excellent ventricular function and a good quality of life, despite angiograms showing severe CAD; for these people, a “wait and see approach” may be appropriate. For others who are suffering from the symptoms of arterial blockages, which can increase risk of heart attack, surgery is probably the best option. Surgery is necessary when the left main coronary artery is blocked more than 70 percent, or where two or more other major coronary vessels are narrowed by 90 to 95 percent, and when the blockages have led to an “unsatisfactory” quality of life.
Symptoms that contribute to an “unsatisfactory” quality of life may include frequent attacks of angina (“heart cramps”), becoming short of breath with just minimal exertion, and not being able to walk up a short flight of stairs or enjoy physical hobbies like golf and playing with children or grandchildren. People whose lives are so limited are generally not in a position to wait for the gradual relief that bypass alternatives such as medication, targeted supplementation and lifestyle modification (e.g. eating healthy and managing stress) can bring. If you experience such symptoms, bypass surgery can give you another chance to try to prevent the need for a second or third bypass surgery by adopting alternative lifestyle options.
Now, chelation therapy involves administering a chelating agent to help leach heavy metals like lead, cadmium and aluminum out of the body. Doctors use it to help treat a variety of CVD-related conditions. EDTA is given intravenously through a series of 20 to 40 office treatments, or orally (Detox/MaxPlus is an oral formula). Some of the reported benefits of chelation include significant improvement in blood flow and symptoms for patients with atherosclerosis, hypertension, angina, circulatory disorders, and diabetes. The theory behind chelation therapy is that removing toxic metals from the blood improves the ability of endothelial cells (which form the lining of blood vessels) to fend off free radical activity and to produce nitrous oxide necessary healthy arterial dilation.
While many doctors use chelation for toxic metal removal in CVD patients, organizations such as the American Heart Association have not yet sanctioned its use. This is probably due to the lack of controlled studies needed to prove chelation’s efficacy. In 2003, however, the National Heart, Lung and Blood Institute and the National Institutes of Health began a double-blind study to test the effects of 40 infusions of standard EDTA chelation therapy on heart attack survivors. More scientific evidence, then, should be available about the effects of chelation therapy upon completion of the study in June 2012.
Chelation therapy is a gradual process that can help improve quality of life. However, substituting it for surgery can increase one’s risk of a heart attack, if surgery is in fact necessary. Bottom line: surgery is the best option to increase blood flow for a symptomatic patient with 4-vessel disease, but only if the patient has unsatisfactory quality of life.
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Please note that Dr. Sinatra does not provide medical advice through Heart MD Institute; any and all information found on this site is intended solely as an informational tool, and it should never replace a visit to your physician, nor be considered advice upon which you rely when making health-related decisions.
*Indicates that Q&A has been reprinted or adapted from Candid Advice About Your Heart, a Heart, Health & Nutrition supplement, with permission from Healthy Directions, LLC.
**Indicates that Q&A has been posted in response to emails or comments submitted to Heart MD Institute. © 2012 Heart MD Institute. All rights reserved.