Heart+Failure

Western Diagnosis --also called congestive heart failure (CHF) --abnormal mechanical performance of the heart --results in inadequate CO to meet body’s needs --an end stage for many cardiac disorders

Etiology
1. anything that affects L vent function by either increasing CO or decreasing myocardial function 2. valvular, CAD, myocardial disease 3. inc CO - anemia, thyrotoxicosis, pg, liver disease

Pathophysiology
1. inc CO or dec myo fcn result in incomplete emptying of L vent 2. raises venous and capillary pressure in lungs and produces congestion 3. inc peripheral vascular resistance to maintain BP 4. inc L vent pressure, more dec in fcn 5. reduced contractility 6. low CO and pulmonary congestion 7. LV failure - fatigue and exertional dyspnea 8. RV failure - from LV failure: venous congestion - hepatic engorgement - peripheral edema 9. pulmonary - pulmonary venous hypertension: dyspnea 10. renal blood flow and GFR dec: total body Na and water inc -> congestive clinical manifestations 11. hepatic blood flow dec due to inc venous pressure: liver engorgement-> liver necrosis and failure 12. pulm signs and sxs from LHF 13. liver signs and sxs from RHF

Signs & Symptoms
1. tachycardia 2. fatigue on exertion 3. exertional dyspnea 4. cold intolerance 5. paroxysmal nocturnal dyspnea 6. nocturia 7. cough with blood tinged sputum 8. sense of suffocation with extreme dyspnea, cyanosis, tachypnea, anxiety, pallor, diaphoresis may incite acute pulmonary edema-life threatening 9. fullness in neck and abdomen 10. ankle swelling 11. cyanosis 12. wheezes and rales in lungs 13. diffuse PMI 14. enlarged, tender liver 15. ascites 16. pitting ankle edema

Testing
1. no specific ECG changes 2. chest x-ray --pulmonary venous congestion --inc vascular markings 3. echocardiography 4. CBC 5. chem screen 6. Brain Natriuretic Protein [should be <100pg/ml.] - a response to excessive fiber stretching, essentially diuretic by excreting Na

Treatment
1. control underlying disease processes 2. avoid salt and alcohol 3. rest 4. diuretics - [dandelion leaf, watermelon seeds work well] 5. ACE inhibitors [decreases vasoconstriction and Na retention] - don't give anyone on ACE inhibitors potassium 6. nutrition --Ca 1 gm/d --Mg 500 mg/d --K 100 mg/d - useful if not taking an ACE inhibitor --Coenzyme Q10 100-300 mg/d [300 and possibly up to 600 in heart failure] --carnitine 1 gm/d --taurine 3 gm TID --arginine 2-4 gm TID

Research those taking Omega 3 (fish oil) showed less hospitalization and death in cases of heart failure vitamin D deficiency may be implicated Thiamine (B1) - those w/ heart failure showed to have low levels of thiamine

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============================================================================= IBIS:

Definition:
A clinical syndrome where the heart is unable to pump blood forward normally, causing congestion in the pulmonary and/or systemic circulation, and decreased blood flow to the body tissues due to diminished cardiac output. Also called "dilated or congestive cardiomyopathy".

Etiology:
CHF results from primary changes in the myocardium caused by secondary factors creating increased cardiac work. It is thought to be the end result of a variety of toxic, infectious, and metabolic agents adversely affecting the heart tissues, including anemia, thyrotoxicosis, infection, embolism, arrhythmias, dietary excess and so on. Congenital heart defects are also major risk factors to developing CHF later in the life of the patient.

Somatic Therapies:
• aerobic exercise program: for prevention, after diagnosis, mild aerobic exercise prescribed by stress test assessment. In a year long, controlled trial, Belardinelli et al reported significant enhancement in quality of life and improvement in functional capacity in individuals with CHF who engaged in exercise training. (Coats AJS. Lancet 1990;335:63-66; Belardinelli R, et al. Circulation 1999;99:1173-1182.) • qigong • tai qi chuan

Nutrition:
eating principles: • low sugar • low fat diet with unsaturated fats • calorie percentages: 70% complex carbohydrates, protein 12-15%, fat 15-18% • high fiber • low cholesterol • low Sodium/Sodium-restricted diet • vegetarian cleansing diet or short fasts • foods that cool the Liver and Stomach • Fasting, General Sample Diet, General Guidelines for Eating, Sample Vegetarian Diet

specific remedies: • take 15 g of mango skin and 30 g of kernel from the fruit stone. Steam in water and serve per day (Yin-fang and Cheng-jun, 35.) • eat fresh pineapple two to three times daily (Yin-fang and Cheng-jun, 79.) • crack open a fresh coconut and drink the juice three times daily (Yin-fang and Cheng-jun, 86.)

avoid: • meat, alcohol, milk, hot sauces, spicy foods, fried foods, fatty foods, rich foods, salty foods

Botanicals
• Apocynum cannabinum (toxic): state of debility; slows heart action, increases arterial tension, edema (Felter, p. 193) • Asclepias incarnata (toxic): diuretic for edema; its action on edema is similar to Digitalis purpurea (toxic) but does not irritate the mucous membranes (Felter, p. 225) • Capsicum frutescens: stimulant to heart and circulation (Felter, p. 275) • Convallaria majalis (toxic): edema, feeble circulation, dyspnea (Felter, pp. 321, 322; British Herbal Pharmacopoeia, p. 74) • Crataegus oxyacantha: hypertrophy, overwork, weakness, cardiotonic (Felter, p. 326; British Herbal Pharmacopoeia, p. 75) • Cytisus scoparius: cardiac edema, myocardial weakness (British Herbal Pharmacopoeia, p. 192) • Digitalis purpurea (toxic): hypertrophy, dilatation (Felter and Lloyd, p. 656; Weiss, p. 126) • Leonurus cardiaca: cardiac symptoms associated with neurosis, cardiac debility, nervous debility and irritation, restlessness (British Herbal Pharmacopoeia, p. 130; Felter, p. 443) • Lycopus virginicus: hypertrophy, dilatation; irritability, irregularity of heart (Ellingwood, p. 224) • Selenicereus grandiflorus (toxic): (Ellingwood, pp. 213, 214) • Strophanthus kombe or gratus (Weiss, p. 140) • Taraxacum officinale (leaf): as a diuretic (NCNM Botanicals) • Urginea maritima (toxic): diuretic (Weiss, pp. 144, 145)

Chinese Formulae
• Hoelen Five Herbs F. (Wu Ling San); Qu Shi (Alisma and Hoelen 16) (patent): Water Stagnation: edema, diarrhea, urinary difficulty, shortness of breath (Hoelen 5 Herbs F.: Hsu, 1980, p. 516; Yeung, p. 244; Dharmananda, 1986, p. 173; Bensky and Barolet, p. 174; Qu Shi: Fratkin, p. 268) • Vitality C. (Zhen Wu Tang): Kidney Yang Xu (Deficiency), Edema: edema, loose stools, dizziness, heavy sensation in head, swollen tongue with toothmarks (Hsu, 1980, p. 278; Yeung, p. 287; Dharmananda, 1986, p. 207; Bensky and Barolet, p. 197) • Gecko A (patent); Shen Jie San: Kidney Yang Xu (Deficiency) and Kidney Qi Xu (Deficiency) (Gecko A: Dharmananda, 1990, p. 17; Shen Jie San: Yeung, p. 200) • Stephania and Ginseng C.: Water Stagnation, Edema (Hsu, 1980, p. 500)

Acupuncture
after assessing the person and palpating, consider these patterns: Heart and Kidney Yang Qi Xu (Deficiency); Dampness overflowing; Water Stagnation; Kidney Yang Xu (Deficiency); Kidney Yang and Qi Xu (Deficiency)

» see also "edema"

» illustrative combinations: • CV-2 joined to CV-3; CV-9, UB-28, Kd-7, Kd-5, Sp-9 and UB-58 to "facilitate urination and eliminate edema (i.e., to circulate the Yang so as to benefit the water)" while treating chronic heart failure (Shanghai, p. 595) • UB-15, Ht-7 and St-40 for pulmonary heart disease (Shanghai, p. 202) • Ht-7, UB-15, UB-23, Ht-9, Kd-8, St-36, St-43, GB-30, LI-4, Sp-6, TW-7 and CV-5 for cardiac edema (Mann, p. 111) • St-28 and CV-9 (D both), then needle St-36 and CV-7 for "water diseases which are among the most insufferable and abdominal fullness and vacuity distention failing to disperse" (Ellis, et al, 1988, p. 128) • UB-13, Kd-27, CV-22, CV-17 and LI-4: facilitate respiration; eliminate wheezing; relieve cough • UB-18, Lv-13 and Lv-3 (-) spread Liver Qi; dispel Xue Yu (Blood Stasis); remove Liver distension effecting flanks • CV-9, CV-3 -> CV-2 and Sp-9 (-): rid edema through urination • PC-6, PC-5 and Ht-8 or PC-6, PC-4 and PC-3, with max. 6 - 7 other points as indicated (Shanghai, p. 595); all above points strengthen the Heart and calm the Shen; also consider CV-12, St-25, CV-6, St-36 to tonify the Center, benefit the Qi; CV-4, St-29 and CV-6 to set the Lower Warmer in motion; CV-9, CV-3 through to CV-2, St-28, Kd-7, Kd-5, UB-58 and Sp-9 to open Yang and facilitate water shift; Lv-3, Lv-13 and UB-18 to scatter effused blood; UB-13, CV-22, Kd-27, CV-17, Ht-8 and LI-4 to relieve asthma, cough and extrude sputum (Lee and Cheung, p. 243) • CV-3 -> CV-2 (-): rid edema through urination; tonify the Kidney Qi and Yang; regulate the Bladder and Water Pathways

Homeopathy
• Arnica montana: vertigo, heaviness and cerebral affection; plethoric people with tendency to hemorrhage • Arsenicum album: great prostration; palpitation, irregular pulse, arrhythmia, dyspnea on ascending • Cactus grandiflorus: constricting pain, < daytime; dyspnea; > lying on back; sadness • Carbo vegetabilis: gastric derangement, cold sweat, burning; > fanning, eructation • Digitalis: heart block; weak irregular slow pulse, sensation as if heart stood still; cannot move; "tobacco heart" • Glonoinum: before convulsion; nervous irritation; atrial flutter; < from exertion • Lycopodium: palpitation at night, after eating and during digestion; ischemic heart disease; structural changes with anxiety

Subtle Support
• notes: A, A#, B, C, C#, D, D#, E, F#, G, G#

• chords: dominant 7th, diminished 7th, A Major, A# Major, C Major, G Major, G# Major (Gimbel, p. 116)

cardiovascular: • The Barcarole • The Blue Danube • Chopin's A minor Waltz • Tango music • Humoresque • Cui's Orientale • Song of India • Donna e Mobile • Oley Speak's Sylvia (Heline, p. 18)

Mind/Body
• Emotional difficulties of a chronic nature were found to be an integral part of daily living in 26 of 30 patients in this study. (Locke, 1985, p. 144) • Need to fulfill one's heart's desire is not satisfied; emotional congestion usually accompanied by depression, melancholy, and strong feelings of being detached from one's life. (Shealy, p. 162) • Heart represents center of love and security; Heart problems are associated with longstanding emotional problems; lack of joy; belief in strain and stress; hardening of the heart. (Hay, 1984, p. 168)

Chinese psychophysiology: • Heart ~ Xin houses the Shen (Spirit) and reveals itself through the brightness in the eyes; rules the Xue (Blood) and its vessels and directs the circulation, and relates to the integration of the organs and the personality. » Healthy expressions are warmth, vitality, excitement, inner peace, love, and joy. » Heart Xu (Deficiency) signs include sadness; absence of laughter; depression; fear; anxiety; shortness of breath (Seem, p. 28); cold feeling in the chest and limbs; palpitations; cold sweat; inability to speak; memory failure; nocturnal emissions; and restless sleep. » The Heart is the Emperor of the bodily realm so that when the Heart is disturbed all the other organs will be disrupted.

• Spleen ~ Pi governs digestion and manifests in the muscle tissues; resolves Dampness and Phlegm; governs the Xue (Blood); maintains upbearing; and relates to the ability to assimilate, stabilize, and feel balanced and centered. » Healthy expressions are fairness, openness, deep thinking, and reminiscence; » Spleen Xu (Deficiency) signs include slightness (deficient "form"); abundant elimination; morning fatigue; cold, wet feet (Seem, p. 28); abdomen taut and distended like a drum; craving for sweets; flatulence; nausea; mild edema; memory failure; heavy feeling in legs; easy bruising; pale lips; loose stools; muscular weakness; and, indirectly, obesity. Unresolved Spleen Xu (Deficiency) will ultimately shift into Spleen Shi (Excess) as Dampness accumulates. » Spleen Shi (Excess) signs include heaviness (excess "form"); large abdomen; great sighing; sadness; obsessions and nightmares (Seem, p. 28); abdominal pain; irregular appetite; stickiness in the mouth and on lips; red lips; chest congestion; fatigue; and constipation. » The excessive use of the mind in thinking, studying, concentrating, and memorizing over a long period of time tends to weaken the Spleen and may lead to Xue Yu (Blood Stasis). This also includes excessive pensiveness and constant brooding. (Maciocia, p. 241) Likewise, inadequate physical exercise, overexposure to external Dampness, and excess consumption of sweet and/or Cold foods will also deplete the Spleen.

• Lung ~ Fei is the home of the Po (Corporeal Soul); governs the Qi; regulates the rhythm of respiration, the pulse, and all bodily processes; relates to strength and sustainability; moves and adjusts fluid metabolism; extends through the skin, and controls the pores. » Healthy expressions are righteousness and courage. » Weakness, dysfunction, and illness associated with excessive grief, sadness, worry, and depression. » Lung Xu (Deficiency) signs include cold shoulder and back; changing complexion; and inability to sleep (Seem, p. 28); shortness of breath; changes in urine color; rumbling in the bowels with loose bowel movements; pallor; malar flush; chills; sniffles; sneezing; light cough; and sensitivity to cold.

• Kidney ~ Shen stores Jing (Essence) and governs birth, growth, reproduction, development, and aging; houses the Zhi (Will); expresses ambition and focus; governs Water to regulate body fluids; and displays the effects of aging, chronic degenerative processes, and extreme stress. » Healthy expressions are gentleness, groundedness, and endurance. » Kidney Xu (Deficiency) signs include indecisiveness; confused speech; dreams of trees submerged under water; cold feet and legs; abundant sweating (Seem, p. 28); hearing loss; fearfulness; apathy; chronic fatigue; discouragement; scatteredness; lack of will; negativity; impatience; difficult inhalation; low sex drive; lumbago; sciatica; and musculoskeletal irritation and inflammation, especially when worse from touch. » Intense or prolonged fear depletes the Kidney. Often chronic anxiety may induce Xu (Deficiency) and then Fire within the Kidney. (Maciocia, p. 250) Overwork, parenting, simple aging, and a sedentary or excessively indulgent lifestyle all contribute significantly to Kidney Xu (Deficiency).