Heart Failure

Question 1

Heart failure

Answer 1

Heart failure (HF) = a syndrome in which the heart is impaired as a pump ― failing to supply sufficient blood flow.

Question 2

Heart failure: Signs and Symptoms

Answer 2

Breathlessness (on exertion, at rest, orthopnoea), nocturnal dyspnoea, fluid retention (e.g., ankle oedema, abdominal swelling), fatigue, exercise intolerance, lightheadedness, syncope, tachycardia.

Question 3

Heart Failure: Complications

Answer 3

Atrial fibrillation, ventricular arrhythmias, CKD, sudden cardiac death.

Question 4

Heart Failure: Allopathic Approach

Answer 4

Digoxin (a synthetic form of digitoxin, from Digitalis purpurea (foxglove) that increases the force of myocardial contraction), diuretics, calcium channel blockers, ACE-inhibitors.

Question 5

Heart Failure: Causes and Risk Factors

Answer 5

• Results from various CV conditions ―e.g., IHD (most common cause ―review previous risks), hypertension, AF, cardiomyopathy, LVF, pulmonary hypertension, heart valve abnormalities.
  –See earlier risk factors, e.g., smoking (leads to LV hypertrophy and systolic dysfunction); raised homocysteine; sedentary etc.
• Co-morbidities (so causes of each apply) ―e.g., CKD, anaemia, T2DM, thyrotoxicosis, hypothyroidism, COPD all impair functional status and prognosis of HF.
  –CKD causes a chronic proinflammatory state that can result in atherosclerotic lesions and myocardial fibrosis.
• IR ↓ myocardial glucose utilisation and ↑FFA oxidation -> ↑ myocardial oxygen consumption and the generation of ROS. This impairs cardiac contractibility by changing sarcoplasmic reticular calcium stores and ↑mitochondrial dysfunction.
  *Obesity ―alters cardiac structure, promotes endothelial dysfunction, contributes to IR and↑ inflammatory cytokines.
• Nutrient deficiencies ―CoQ10 (normally ↓ ROS and ↑ NO), vitamin D (normally ↓ inflammatory cytokines and ↑ calcium absorption etc.), B1(common in HF due to chronic alcohol ingestion; normally acts as a coenzyme for glucose metabolism). Also vitamin B2, folate, B12, Ca, Cu, Mg, Mn, K, Se, Fe—needed for normal cardiac metabolism.

Question 6

Heart Failure: Nutrients

Answer 6

CoQ10
D-Ribose
Magnesium
B 1
L-Carnitine
Hawthorn

Question 7

Heart Failure: CoQ10

Answer 7

300 - 400 mg /day

Cardiac myocytes contain >3500 mitochondria / cell and require the highest levels of ATP activity. CoQ10 is essential in the ETC and is a powerful antioxidant. CoQ10 depletion is associated with worse HF outcomes.

Question 8

Heart Failure: D-ribose

Answer 8

Dose: 5 -15g daily

Has been shown to regenerate low myocardial ATPwith an accompanying improvement in ventricular function following ischaemia. Symptom improvements (e.g., fatigue) in chronic HF have been observed.

Question 9

Heart Failure: Magnesium

Answer 9

Dose: 400 - 800mg/day

Critical for ATP. When deficient increasesRAAS (increasing BP), predisposes to low K and may worsen cardiac contractility, increase vasoconstriction and deplete cardiac energy stores.

Question 10

Heart Failure: Thiamine (B1)

Answer 10

Dose: 100 - 200mg/day

Thiamine is a required coenzyme in energy-producing reactions —fuelling myocardial contraction. Note: CVD drugs e.g., diuretics cause a B1 deficiency.

Question 11

Heart Failure: L-carnitine

Answer 11

Dose: 2000 - 3000 mg/day

Facilitates the transfer of fatty acids across mitochondrial membranes to initiate beta-oxidation. The heart uses free fatty acids as its main energy source!

Question 12

Heart Failure: Hawthorn

Answer 12

Dose: 1000 - 1,500 mg

Benefits have been observed in cases of chronic heart failure. This is attributed to hawthorn’s vasodilatory effects on the coronary arteries and potent antioxidant properties. Increases NO.