By Stephen T. Sinatra, M.D., F.A.C.C., F.A.C.N., C.N.S., C.B.T.
Congestive heart failure, a condition in which the heart has weakened and can no longer efficiently circulate blood throughout the body, afflicts approximately 5.7 million people in the United States; sadly, it plays a role in approximately 1 out of every 9 deaths.
If you or a loved one has been diagnosed with heart failure, know that it’s not a death sentence, that there’s hope…There are treatments and lifestyle approaches that can help improve quality of life and lessen risk of having a future cardiac event. Let’s look more closely at those options, along with the causes and symptoms of this disease:
- The Cause of Congestive Heart Failure
- Congestive Heart Failure Symptoms
- Diagnosis & Classification of Heart Failure
- Heart Failure Concerns Unique to Women
- Effective Heart Failure Treatments
What Causes Congestive Heart Failure?
Congestive heart failure is usually the culmination of years of cardiovascular disease, as the heart simply wears out from years of expending more energy than it can produce. When that energy deficit reaches a critical point, heart failure begins.
This energy starvation can be traced to a wide range of causes—longstanding high blood pressure, working extra hard to pump blood through narrowed arteries, and trying to repair tissues that have become damaged or diseased through infection or heart attack being just three of them. Congenital heart defects, diabetes, nutrient deficiencies, alcohol abuse, and chronic stress also can contribute to heart failure.
What Are the Symptoms of Congestive Heart Failure?
One of the biggest heart failure symptoms is edema, or fluid retention.
As blood flow slows, fluid builds up in the in the veins, causing swelling. One way to monitor for this is to push on your feet and ankles with your thumb or finger each evening and see if any of the depressions spring back to shape. If they don’t you should see your doctor.
Other heart failure symptoms include—
- Shortness of breath, especially when lying down
- Tiredness, feeling run down
- Persistent wheezing or cough (caused by fluid build-up in the lungs, or pulmonary congestion)
- Swollen ankles, feet and legs due to fluid build-up (edema)
- Increased heart rate
- Nausea or lack of appetite
- Confusion, inability to think clearly
Although both men and women experience similar symptoms when it comes to heart failure, women tend to have more trouble catching their breath during exercise. If you are a woman over 40 years of age and experience unusual shortness of breath during exercise—or shortness of breath without exertion—ask your doctor for an echocardiogram test. This is especially important if you also have hypertension or mitral valve prolapse.
Heart Failure Diagnosis and Classification
To diagnose congestive heart failure, your cardiologist will perform an echocardiogram. This noninvasive procedure allows your doctor to see (and hear) the size, structure, and function of your heart.
During the echo, we’re specifically evaluating your ejection fraction (EF)—the percentage of blood that the heart is able to expel on each contraction. Healthy hearts have EFs of 50 or higher. Hearts with an EF of 40 or lower are considered to be failing.
The magnitude of failure is classified according to a four-stage scale:
- Stage 1: Ordinary physical activity causes no shortness of breath, fatigue, or palpitations
- Stage 2: Patients are comfortable at rest, but may experience shortness of breath, fatigue, or palpitations with ordinary physical activity
- Stage 3: Patients are comfortable at rest, but any physical activity—ordinary or less—causes shortness of breath, fatigue, or palpitations
- Stage 4: Patient experiences shortness of breath, fatigue, and palpitations while at rest; symptoms worsen with exertion
Heart Failure Concerns Unique to Women
Despite the fact that a little more than half of people living with congestive heart failure are women, the disease is often under-diagnosed and undertreated. This may be due to a tendency among women to not associate their symptoms with heart troubles, but it is equally likely—if not more so—that doctors may be unfamiliar with some of the following risk factors, which are unique to women.
Higher Risk of Diastolic Dysfunction and Failure
There are two types of heart failure: systolic and diastolic. Each corresponds to a different phase of the heartbeat.
Systolic heart failure is the heart’s inability to contract forcefully enough to circulate blood. The risk factors for systolic heart failure are similar in both men and women: a history of coronary artery disease, previous heart attack, and long-term high blood pressure.
Diastolic heart failure is the inability of the heart to stretch and fill with blood between contractions. It is caused by diastolic dysfunction (DD)—a problem less easily detected during an echocardiogram, yet the primary cause for heart failure in women. Because physicians may not detect this early stage DD, disease can progress for years without treatment.
It’s been suggested that women experience a higher incidence of DD because they are more prone to mitral valve prolapse and because their blood vessels are smaller. Women with hypertension need to be especially wary of DD due to this difference.
High Blood Pressure During Pregnancy
It happens rarely, thankfully, but post-partum cardiomyopathy can cause heart failure in women of child-bearing age. Typically the condition presents during the last month of pregnancy and up to five months after delivery. Post-partum cardiomyopathy is thought to be the result of pregnancy-induced high blood pressure and pre-eclampsia (hypertensive crisis), but more research is needed.
Acute Emotional Trauma
Sudden onset heart failure that’s caused by emotional distress is referred to as “broken heart syndrome (BHS)” or “stress cardiomyopathy,” and it affects women far more than men.
The heartbreak experienced upon the sudden death of a loved one is one example of BHS; however, the syndrome also can be brought on by life-threatening feelings experienced during events that bring on fierce surges of adrenaline. Though these sudden feelings can cause symptoms that are similar to those of a heart attack, most tests will return normal results. The only physiological indication of BHS heart failure is a peculiar pattern that can be seen in an echocardiogram, in which the left ventricle balloons outward in an unusual way.
Downplaying Symptoms as the “Pains of Aging”
Though you may expect the opposite, women will downplay their symptoms of physical discomfort more often than men, dismissing them as a normal result of caring for children, aging parents, and spouses. As a result, many women become vitally exhausted and place unnecessary and unusual stress on the heart, which can lead to dysfunction.
It is essential that women share their physical limitations. Often, what may seem a minor symptom for you can be a major clue for your doctor—and an important part of preserving your health, or even your life.
Effective Heart Failure Treatments
The good news is that appropriate treatment can help heart failure patients reduce and manage their symptoms, and improve their quality of life. The most effective therapies will include these conventional and alternative options:
All heart failure treatments must begin with a diet rich in foods that help reduce oxidation and arterial inflammation, lower blood pressure, and improve blood flow. These lessen energy demand in the heart, which means, it will be better able to deliver life-giving nutrients even in a weakened state. Learn about my PAMM Diet.
Nutritional Supplementation with the Awesome Foursome
Cells throughout the body—but especially in the heart—need adequate levels of coenzyme Q10, magnesium, L-carnitine, and D-ribose in order maximize energy production. Supplementing with these nutrients helps ensure that the heart has the raw materials required to produce and burn ATP, the most basic form of energy. This is critically important in failing hearts, which cannot produce adequate energy to pump efficiently.
Drug Therapies and Natural Alternatives
Traditional congestive heart failure treatment centers on medications like digoxin (digitalis), diuretics, ACE inhibitors, beta blockers, and nitroglycerine. These pharmaceuticals help relax artery walls, lower blood pressure, control heart rate, improve blood flow, and reduce the amount of energy consumed in the heart—but their long-term use also creates side effects.
More natural alternatives can help heart failure patients avoid the nutrient depletion, weakness, fatigue, lung congestion, vision disturbances, arrhythmias, gastrointestinal distress, headaches, and depression associated with long-term use of such heart failure medications. Options include:
- Hawthorne berry. This herb is used in Europe as a substitute for the blood pressure and anti-arrhythmic drug digoxin (digitalis). Do not use digoxin and hawthorne berry together, as they have a similar effect on the heart.
- Mineral supplements. If you don’t have kidney problems, you can reduce your reliance on calcium channel blockers by taking magnesium, potassium, and calcium. Secondarily, supplemental potassium and magnesium can help offset the minerals lost due to diuretic use. Food sources, such as raisins, prunes, apricots, bananas, potatoes, oranges, spinach, avocados, turkey, fish, chicken, and peas, are recommended in addition to supplements.
- Ginger tea. Ginger tea and uva ursi extract may help those with mild fluid retention.
- CoQ10, squid or fish oil, garlic, and L-arginine. Use these nutrients as an alternative to ACE inhibitors.
Beta blockers are among the safest of all drugs prescribed to lower blood pressure, prevent heart damage, and relieve angina. They are one of the only cardiac drugs that shouldn’t be replaced with a more natural alternative.
NOTE: do not reduce or stop taking your medications without your doctor’s consent and guidance.
- Centers for Disease Control and Prevention. Heart Failure Fact Sheet.
- Heart Failure Society of America. Heart Failure Facts and Information. Accessed December 11, 2016.
- Heart Failure Society of America. Stages of Heart Failure. Accessed December 11, 2016.
- Sinatra ST. Natural Treatments for Congestive Heart Failure. Drsinatra.com. Accessed December 11, 2016.
- Sinatra ST. Heart Sense for Women. 2000. Lifeline Press.
- Sinatra ST. Reverse Heart Disease Now. 2008. Wiley & Sons.
- Sinatra ST. The Sinatra Solution: Metabolic Cardiology. 2015. Basic Health Publications, Inc.
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