Heart strain is the precursor to heart failure or congestive heart disease. We are finding it more often than expected and at younger ages. Why? Because damaged but treatable heart valves heart chambers or heart muscle problems are epidemic. Why? Because we force down blood pressure with drugs and that strains the heart. Why? Because drugs can deplete Co Q 10 and other heart nutrients. Why? Because no one told you excess fat cells, immune problems or infections, damaged kidneys or insulin/glucose problems could damage heart muscle or valves. Why? Because conventional methods wait until the person developed classic symptoms before making the diagnosis, If you think about it, we are diagnosing heart attacks, high blood pressure and diabetes at younger ages; it’s no surprise we’d find heart strain.

The American Heart Association has changed methods to classify patients. Class A heart strain or heart failure means high risk, but without structural changes or classic symptoms. These patients are often overweight, sedentary, have high or low blood pressure, abnormal insulin or glucose, a history of infections, abnormal kidney functions, abnormal cholesterol, family history of “heart disease”, are smokers, etc. and need preventative education and treatment. Other indicators include high C reactive protein or homocysteine, kidney disease, abnormal testosterone and low heart rates or blood pressure.

Class B heart strain or heart failure means structural changes occasional seen on ECG (or EKG) but commonly seen on cardiac ultrasounds (echocardiograms), such as enlarged heart chambers or leaky valves but without classic symptoms (leg swelling, lung congestion, shortness of breath or high blood pressure). Common symptoms include fatigue, anxiety and mood changes, sleep disturbances, vague breathing symptoms, minimal swelling, constipation, irritable bowel or heartburn, especially in women. Structural changes are seen on ECG or cardiac ultrasound but often not told to patients in the early stages. Mitral and aortic valve problems are now classified here and warrant follow up.

Class C heart strain or failure means structural changes (seen on ECG, cardiac ultrasound or other tests) and classic symptoms (any combination of fatigue, fluid retention, high blood pressure and short of breath), often requiring treatment changes and drug adjustments. Class D means severe symptoms, even with drugs.

We commonly recommend supplements, magnesium and B vitamin shots with good success rates for heart strain and heart failures. We always treat heart problems with advice on improving lifestyle and food intake. Ask for our health diets or schedule an appointment for advice.

The drugs we were trained to use (diuretics, digoxin) may relieve symptoms but do not prevent long-term consequences. Newer studies specify which drugs and doses are optimal (see Part 3 & 4). Furthermore, many cardiac drugs, especially statin cholesterol drugs, deplete B vitamins, Co Q 10, minerals and other nutrients necessary for heart functions, contributing to heart failure risks. To make matters worse, new data indicates some diabetic pills may contribute to heart failure for some people and statin drugs cause diabetes in 9% of cases.

So what can you do? Choose to change your thinking, get educated, review your heart tests with a practitioner who treats early or “mild” findings, tests for nutritional deficiencies, works on abnormal lab tests and use drugs or alternative medicines as indicated. If you want advice on changing food intake or healthy lifestyle changes – schedule an appointment.

Cardiac drugs work better if nutritional deficiencies are addressed, so consider doing Spectracell micronutrient testing. With appropriately chosen supplements, magnesium or B vitamin shots we see less side effects, use lower drug doses or avoid drug. Certain drugs deplete or increase potassium and other nutrients and can damage the kidneys, so frequent blood tests are needed to prevent side effects. We get better results if we test for and treat the multiple overlapping causes of heart damage (weight, immune, infection, kidney, glucose problems, etc.), which is covered in other handouts or appointments.

I personally have Class B heart strain due to immune problems, infections, blood vessel damage, genetic and insulin/glucose problems and am managing very well. My father and mother wouldn’t listen to me, just followed cardiologist’s advicde and suffered, then died from heart failure.

Heart Strain or Heart Failure, Part 2

There are different types of heart strain and heart failure. Major types include systolic or diastolic (with or without preserved left ventricle functions), left and right ventricle problems or both, hypertensive, hypotensive (low blood pressure), ischemic (reduced oxygen and blood flow to the heart), congested and non-congested. It requires additional tests, time and responses to treatments to sort these types out. Unfortunately, there can be a lot overlap between the types.

Up to 50% of patients have normal left ventricular systolic function (ejection fraction on cardiac scans > 40), but these patients account for about 50% of hospital admissions. Those with systolic heart failure are more common at any age, more typically male, typically have coronary artery disease, prior heart attack and higher risks. Classic symptoms often include fatigue, shortness of breath, poor blood flow to organs and lung congestion (in the later stages), but also chest pain.

Those with diastolic dysfunction are more typically female, have high blood pressure, have high glucose, insulin defects and are overweight.

Those with left heart strain or failure more commonly include enlarged heart chambers, fatigue, shortness of breath with activities and poor blood flow and oxygenation to internal organs. Those with high blood pressure, cardiomyopathy (muscle problems), heart valve problems and congenital heart defects more commonly have left heart strain or failure.

Those with right heart strain or failure more commonly have leg swelling, neck swelling, abdominal fluid retention, fatigue, lung fluid accumulation and liver congestion. Those with right ventricle problems more commonly have sleep apnea, emphysema or chronic bronchitis, pulmonary artery or valve problems, mitral stenosis, lung blood clots, pulmonary hypertension or right sided heart attacks.

Conditions that can mimic or cause heart strain or failure include immune problems, heart valve problems (especially aortic stenosis), pulmonary hypertension, coronary insufficiency (hard to diagnose in women and early stages), sleep apnea, kidney insufficiency, thyroid disease, anemia and other conditions.

If you take heart drugs, and many people have to, you decrease the chance of progressive damage by about 30%. If you can exercise and safely lose 5-10% of body weight (if overweight), you can improve the outcomes by up 40-60%. Supplements help in the early stages or help prevent drug side effects or optimize drug responses.

The primary goals and management includes education, supplements, magnesium or B vitamin shots as needed (especially in the early stages) and various classes of prescription drugs. Specific ACE inhibitors, beta blockers and ARB drugs often slow or reverse disease progression. ACE inhibitors, ARBs, beta blockers, aldosterone blockers, nitroglycerin derivatives and hydraline decrease mortality rates. All of these require careful consideration and monitoring for benefits or side effects and then make adjustments, which means frequent appointments.

In my experience, olmesartan (Benicar) is overall the best choice for most people because it can improve immune functions (immune problems are always present in these cases) while supporting cardiovascular functions and is part of a larger treatment protocol for immune problems and infections that contribute to heart disease.

Heart Strain or Failure, Part 3

No one can predict which drug will work best for you. It takes trial and error and working together to see what helps or harms you. Scientific medical studies can be a helpful guide to managing drugs. Heart strain or failure is caused by a combination of poor lifestyle choices, immune problems, kidney problems, dopamine, norepinephrine and epinephrine problems, fluid overload in later stages and other manageable factors that are difficult to understand, but manageable. The more we work on these factors, the less drugs you need or you get better treatment results with drugs.

Some drugs are proven to improve survival rate, which means they control symptoms better, slow progressive damage, decrease the need for hospitalizations and prolong longevity (you live longer).

Drugs and supplements work best in patients who consume healthy foods (in the right quantities) and exercise regularly (30 minutes most days of the week).

ACE inhibitors block damaging kidney and heart hormones called angiotension. FDA approved ones for use in Heart Failure (especially if reduced left ventricle functions):

Generic name         Initial dose              Survival dose               Maximum
Lisinopril                10 mg 1 X daily        20 mg 1 X daily           40 mg 1 X daily
Captoptril               25 mg 3 X daily        50 mg 3 X daily           100 mg 4 X daily
Enalapril                 5 mg 2 X daily          10 mg 2 X daily            20 mg 2 X daily
Ramipril                 5 mg 1 X daily           10 mg 1 X daily            20 mg 1 X daily
Quinapril               10 mg 2 X daily        20 mg 2 X daily           40 mg 2 X daily

We must monitor potassium and kidney damage tests initially, after every dose change and every 3-6 months. We must monitor for side effects, including immune suppression (which can lead to cough) and increased stroke risk.

Beta blockers block dopamine, norepinephrine and epinephrine activity (commonly present if reduced left ventricle functions, enlarged heart or valve problems) and may preferred with ischemic heart disease and irregular heart beats or palpitations:

Generic name               Initial dose                        Survival dose                       Maximum  

Metoprolol XL            12.5 mg daily                        25, 50, 100                              200 mg daily
or 150 mg daily
Carvediol                     3.125 mg 2 X daily               6.25 or 12.5 mg                      25 mg 2 X daily
2 X daily
Bisoprolol                                                                   2.5 or 5 mg daily                      10 mg daily

We must monitor for slow heart rate, low blood pressure, fatigue, asthma and other side effects. Worsening heart failure on beta blockers is typically controlled with diuretics.

ARBs block kidney and heart hormones called angiotension. Used when left ventricle function is normal, the above are not tolerated or in combinations for more severe symptoms:

Generic name               Initial dose                     Survival dose                        Maxim

Olmesartan              off label dosing reviewed in appointments, otherwise
10 mg 1 X daily       10 mg 2 X daily                    unknown
Lorsartan                25 mg 2 X daily                    50 mg 2 X daily                 100 mg 2 X daily
Valsartan                 40 mg 2 X daily                   80-160 mg 2 X daily         160 mg 2 X daily
Candesartan             8 mg daily                           32 mg daily                        32 mg daily

We must monitor potassium and kidney damage tests initially, after every dose change and every 3-6 months and watch for low blood pressure.

Heart Strain or Failure, Part 4

Drugs and supplements work best in patients who consume healthy foods (in the right quantities) and exercise regularly (30 minutes most days of the week).

In some patients, aldosterone blockers (spironolactone) is preferred or added for worsening symptoms. It helps to reduce fluid retention, slow potassium and magnesium loss that depletes heart functions, prevents palpitations and may decrease scar tissue formation in the heart and blood vessels.

Generic name        Initial dose              Survival dose                Maximum dose
Spironolactone        6.25 or 12.5 mg        25 mg daily                       25 mg daily

We must monitor potassium and kidney damage tests at 1 week, 4 weeks and every 3-6 months.

Additional drugs: note these or longer preferred because, while relieving symptoms, they do not improve survival rate or slow the progression of heart damage. Diuretics can damage the kidneys and accelerate heart damage.

Generic name      Initial dose        Survival dose      Maximum
Diuretics                 varies                   N/A                         minimize to prevent kidney damage

We must monitor for potassium & electrolyte depletion and increases in glucose and cholesterol (with some diuretics).

Generic name            Initial dose                     Survival dose                    Maximum Digoxin                         varies                                N/A                                       minimize use

We must monitor blood levels. Too little is ineffective and too much can be toxic.

For African Americans, those with severe or worsening heart failure and those with nitric oxide problems (erection problems, pulmonary hypertension, other conditions), a special drug called BiDil may be helpful. This is a combination of nitroglycerin derivatives and blood vessel relaxants.

Generic name                  Initial dose                        Survival dose           Maximum 

Isosorbide                           20 mg/37.5 mg                   unknown                   2 tablets 3 X daily
dinitrate/hydralazine       or less 2-3 times daily

Start out on low doses and increase slowly under supervision. Check blood pressure weekly initially and after each dose change. Once tolerated, go to maximum dose, if needed, for best results.







Heart Strain or Failure, Part 5

Supplements for cardiovascular conditions are only reviewed in appointments, for medical and legal reasons. Ones that commonly help our patients include magnesium shots, specific multiple vitamins, specific EFAs, antioxidants, amino acids, specialty herbs and other products. We generally find best results with pharmaceutical grade supplements (available in our office), higher doses as needed and certain combinations.

Just like heart drugs, there are many combinations and doses of supplements that can help. Just like heart drugs, we increase doses or create combinations as needed.

In my clinical journals, every month I read articles how common supplements, available in health food stores or to unlicensed individuals, lack necessary ingredients or have toxic components. We research and offer our own brands and typically see better results.

Drugs and supplements work best in patients who consume healthy foods (in the right quantities) and exercise regularly (30 minutes most days of the week).

If you get your supplements elsewhere, there is no way we can know if they are pharmaceutical grade. Many are not and, consequentially don’t work well. Many contain contaminants, especially toxic substances and/or do not have necessary ingredients. It does no good to purchase an inferior product, get poor results and then think supplements don’t work.

David Overton, PA-C works at Natural Medicines & Family Practice under the supervision of Dr. Richard Faiola, MD, ABFM providing integrated conventional and alternative approaches. He works in conjunction with cardiologists, who tend to focus on the sickest patients only.