Counseling Sheet

Agatha M. Thrash, M.D.
Preventive Medicine

When the heart is unable to keep up with its duty of pumping all blood that returns to it, we call the condition congestive heart failure. That is, the heart is not able to pump out into the arteries all the blood that comes to it through the large veins. When this happens, the veins start to fill with blood, and pressure builds up, which can lead to seepage of fluid into tissues. This build-up of fluid behind the pumping heart can occur either in the lungs or in other parts of the body. In the first case, the person will have some difficulty breathing, especially with exercise. Coughing can be another symptom. When the fluid build-up occurs in the rest of the body there will be swelling which is noticeable particularly in the lower legs and ankles. Other symptoms or signs of heart failure can be fatigue on exertion, intolerance to cold, accelerated heart rate, sudden difficulty breathing when lying down for a time, coughing, pink to brownish-tinged sputum, rapid breathing, restlessness, a sense of suffocation, fullness in the neck or abdomen, paleness, or even a bluish tint to the skin.

The heart failure may be due to factors other than simply a weakening heart muscle, as from a recent or previous heart attack. Some of these other factors would include the excessive demand placed on the heart by anemia, hyperthyroidism, arrhythmias, complications of pregnancy, liver disease, valvular heart disease, and long-standing high blood pressure. In any of these situations, of course, treatment should be directed to these other factors to relieve the heart of its excessive load.

However, in many cases the heart, weakened by one of the above mentioned conditions, has placed on it a large blood volume, as from a high salt diet or kidneys not putting out enough fluid. A few simple measures will help many such cases of heart failure. The first step in treatment would be to reduce salt intake and ideally go on a salt-free diet at least until the symptoms have been eliminated. A salt-free diet requires that not only salt be eliminated in food preparation and from use of salt on the table, but also requires a very careful elimination of all salt found in processed foods. It is this latter point of processed foods we find most difficult to handle: it requires elimination of all canned foods such as vegetables that have salt in the ingredients, elimination of bread containing salt, in it, and elimination of any other processed foods containing salt. Obvious examples such as commercial popcorn and potato chips, etc. must be eliminated along with less obvious examples like boxed breakfast cereals and ice cream, etc. In fact, ice cream is one example of the whole spectrum of dairy foods that has to be eliminated because of the high sodium content in cow's milk. In a number of cases of heart failure, simply going on the salt-free diet will be enough to reduce or eliminate the symptoms. Homemade popcorn, dry cereals, non-dairy ice cream, etc. can all be made without salt.

Further, help in eliminating fluid from the body and thus reducing the load on the heart can be obtained from diuretic herbs like corn silk, watermelon seed, and dandelion leaf. A direct strengthening effect on the heart can be obtained by hawthorn berries. Both the diuretic herbs and the hawthorn berry can be consumed as teas where an adequate dosing would be one to two tablespoons of each in a quart of water, taken several times through the day and made fresh each day.

However, if the heart failure is causing moderately severe problems, it would be best to start with hawthorn and diuretic herb tinctures until improvement begins, as the tinctures can concentrate the active principles without overloading with water. Use one tablespoon of the tincture in one-half cup boiling water (let alcohol evaporate for five minutes before drinking), every two to three hours for the first day and night, then every four to five hours the second day and night, then four doses a day for one week. Then start making the tea. The hawthorn berries (and watermelon seed, if used) should be crushed in a seed mill or blender. They require gentle simmering in the water for 20 minutes, while the corn silk and dandelion leaf can simply be added after removing from the burner and left to steep for another 30 minutes before straining. Make up to one quart. Take one-half to one cup at a time throughout the day.If greater strengthening of the heart is needed, very concentrated extracts of hawthorn along with other herbs are available.

Exercise, of course, does place extra demand on the heart and can bring on symptoms of heart failure; but rather than eliminating it entirely, it should simply be limited so that the difficulty in breathing or swelling, etc. does not become bothersome. In fact, recent studies show that regular exercise is not contraindicated in heart failure, but is actually beneficial. It may need to be started very mildly, in some persons just a few steps at a time. It then can be gradually increased as tolerated - about 30 to 90 minutes a day, at a pace you know you can tolerate.

A hot bath, especially if prolonged, can definitely aggravate heart failure, but a slightly warm or slightly cool bath for about 30 minutes can actually be helpful. In one study a warm bath increased the heart's ability to pump and helped the circulation. Try it for yourself.Coenzyme Q-10 is a nutrient widely used, having a specific effect pf nourishing the heart muscle. It can be purchased at a health food store and obtained from many plants, especially almonds and other nuts, spinach, soy and canola oil, olives, grape seed, and whole grains.

As time goes by with such a program and a well-rounded diet of fruits, nuts, grains, and vegetables, without animal products, there generally will be much improved health in the heart failure patient, and most or all of the usual drugs can be eliminated.