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Dx Heart Failure Treatment:

Heart Failure

The Merck Manual Home Edition states:
"Heart failure can occur in people of any age, even in young children (especially those born with a heart defect). However, it is much more common among older people, because older people are more likely to have disorders that damage the heart muscle,(pumps less efficiently) or the heart valves. About 5 million people in the US (23 million worldwide) have heart failure and about 500,000 new cases occur each year.

Heart failure does not mean that the heart has stopped. (Simplifying) It means that the heart cannot keep up with the work required to pump adequate blood to all parts of the body (its workload).
  The function of the heart is to pump blood:... blood goes out of the heart when the heart muscle contracts (called systole) and comes into the heart when the heart muscle relaxes (called diastole)...In systolic dysfunction, the heart contracts less forcefully and pumps out a lower percentage of the blood that is returned to it. [Heart failure due to diastolic dysfunction develops because the heart muscle stiffens (particularly the left ventricle) and may thicken so that the heart cannot fill normally with blood]. As a result, more blood remains in the lower chambers of the heart (ventricles). Blood then accumulates in the lungs, veins, or both. Blood may also build up in the tissues causing congestion. That is why heart failure is sometimes known as congestive heart failure. Often, both forms of heart failure occur together.... Thus, heart failure becomes even worse (with time and untreated).

*Congenital Heart Disease
*Heart Valve Disease
*High blood pressure
*Coronary artery disease is a common cause of systolic dysfunction. A heart attack destroys an area of heart muscle. As a result, that area can no longer contract normally.
*Myocarditis (inflammation of heart muscle) caused by a bacterial, viral, or other infection can damage all or part of the heart muscle, impairing its pumping ability. There is also a rare form of dysfunctional cellular mitochondria from which James (testimonial below) developed heart failure necessitating heart transplant.
*Drug therapies: steroids, cancer drugs, rare drug effects such as rhabdomyolysis from statins.
*Electrical conduction defects. These can include congenital, after myocardial infarction, atrial fibrillation (AF) and premature ventricular contactions (PVCs).
*Pulmonary Hypertension
*Pulmonary Embolism
*Metabolic disorders: Diseases such as severe hypothyroidism, hypopituitarism (low growth hormone), severe anemia, adrenal disease (Cushing's Syndrome/ Disease) and hypogonadism can contribute to weakened heart muscle contractions and heart failure.
*Constrictive Pericarditis
*Diabetes is a major cause of heart disease. Diabetes can causes 'silent' heart attacks, stiffen the heart tissue from high glucose (hyperglycemia) and decrease blood flow from coronary artery disease.

Spotlight on Aging
Aging alone does not cause heart failure. But older people are more likely to have the most common causes of heart failure, which are long-standing high blood pressure and heart attacks (due to coronary artery disease).

Medications Used in the Treatment:
1. Ace Inhibitors: Prinivil® Zestril®/lisinipril, Accupril®/quinapril, fosinopril,
2. Thiazides: Microzide® hydrochlorothiazide, chlorothiazide, Diuril®/chlorothiazide, methychlothiazide
3. Beta Blockers: Toprol®XL/metrorolol er, propranolol
4. ARBs: Cozaar®/losartan, Diovan®/valsartan, Micardis®/telmisartan
5. Loop Diuretics: Lasix®/furosemide, Demadex®/torsemide, bumetanide, Edecrin®/ethacrynic aid
6. Nonselective Alpha/Beta: Coreg®/carvbedilol
7. Cardiac Glycosides: Lanoxin®/digoxin
8. Nitrates: Lanoxin®/ digoxin. Combinations: Bidil®/ hydralazine 37.5mg- isosorbide dinitrate 20mg
9. Anabolic Steroids: testosterone, DHEA, oxandrolone
10. Aldosterone Antagonists: Aldactone®/ spirolactone, Inspra®/eplerenone
11. ACE Inhibitors: Vasotec®/enalapril, Mavik®/trandolapril
12. Thiazide-Like Diuretics: chlorthalidone, indapamide, Zaroxolyn®/metolazone, Thalitone®/chlorthalidone
13. Potassium Sparing Diuretics: amelioride, amelioride-hctz, Dyrenium®/tramterene
14. Supplements: Co-enzyme Q10, Omega-3, DHEA, L-Carnitor®
multiple vitamins A&E, selenium, zinc, copper
15. Human Growth Hormone: Tev-tropin®,Omnitrope®, Norditropin®, Genotropin®/synthetic human growth hormone

*[Editor] A number of natural vitamins, minerals and supplements are necessary to maintain heart health. These include:

1. Co-enzyme Q-10
2. Omega-3
3. Thiamine and other B vitamins
4. Vitamin D
5. L-carnitine: Carnitor®
6. D-Ribose
7. Minerals: calcium, magnesium, selenium, zinc, iodine

*[Editor] G. Caminiti, an Italian physician, has published 2 peer reviewed journal articles showing that Testosterone injections are beneficial for both men and women with heart disease (NY class II and III).
*Caminiti G. Effect of long-acting testosterone treatment on functional exercise capacity, skeletal muscle performance, insulin resistance, and baroreflex sensitivity in elderly patients with heart failure: a double-blind, placebo-controlled, randomized study. J Am Coll Cardio 2009
*[Editor] G. Caminiti Testosterone therapy in women with chronic heart failure: a pilot double blind randomize, placebo controlled study. J Am Coll Cardiol 2010.
*[Editor] PODCAST Focus on Heart Disease- New Treatments and New Understanding

*[Editor] Screening for H.I.S. or H.E.R. Comprehensive Laboratory tests may offer evidence that simple hormones may be out of balance. With these laboratory tests in hand, discuss them with your health care professional.

Suggested Links
*N.H.S. Choice

*[Editor] Stephen Sinatra, M.D., a noted 'alternative thinking' board certified cardiologist wrote Metabolic Cardiology: the missing link in cardiovascular disease of the vital role of nutrition in the heart cell's biochemistry.
Furthermore, he and others have documented dramatic improvement in heart function (ejection fraction) with massive doses of ubiquinol.
*[Editor] However, a Cochrane Database Review 2013 did not find that the evidence for Coenzyme Q10 for heart failure "warranted a change in practice. Although there was improvement in the New York Heart Association Classification, there was not improvement in left ventricular ejection fraction nor exercise capacity."
*[Editor] Based on the Editor's limited experience, he can find no harm in these individuals whom have limited life-expectancy.

Testimony: Heart Failure at 36. James was refused heart transplant at the state's largest university hospital when his ejection fraction fell below 15%. The decision was based on the medical literature "There is currently no clear evidence supporting the use of any intervention in mitochondrial disorders". He read about the potential benefits of L-carnitine and the dual benefits with ubiqinol (Co-enzyme Q10). James utilized these supplements in mega-doses as Sinatra had reported. Human growth hormone was added as utilized by Fazio. Testosterone replacement for severe hypogonadism was added; later to become a part of the suggested protocol of Naghi. His hormonal imbalances were corrected with additions of cortisol and dehydroepiandrosterone, which "were both independent predictors of ventilatory inefficiency in chronic heart failure". With the addition of nandrolone and oxandrolone, James' ejection fraction rose to normal range of 45% at one-year and remained stable for 13 years; the local TV channel has videotape of him running on a treadmill 12 years after being sent home to die. He exercised for 2-4 hours a day to keep his heart muscle toned. He lived well for a total of almost 14 years, probably longer and better than if he had qualified for a heart transplant.

*[Editor] The Sudden Cardiac Death in Heart Failure Trial identified that failure to identify and treat patients with abnormal thyroid function and heart failure (Erection Fraction <35%) led to a significant increase risk for death.

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