Congestive Heart Failure

Also indexed as: CHF, Heart Failure

Congestive heart failure (CHF) is a chronic condition that results when the heart muscle is unable to pump blood as efficiently as is needed. High blood pressure can cause congestive heart failure. Failure of the heart pump can also result from many other causes, such as severe anemia, hyperthyroidism, heart attacks, and arrhythmias of the heart.

Caution: Congestive heart failure is a serious medical condition that requires expert management rather than self-treatment.

Checklist for Congestive Heart Failure

Rating Nutritional Supplements Herbs
3Stars Magnesium
Propionyl-L-carnitine
Taurine		 Hawthorn
2Stars Arginine
Coenzyme Q10
Potassium		 Arjun (bark extract)
1Star Creatine monohydrate Coleus
3Stars Reliable and relatively consistent scientific data showing a substantial health benefit.
2Stars Contradictory, insufficient, or preliminary studies suggesting a health benefit or minimal health benefit.
1Star An herb is primarily supported by traditional use, or the herb or supplement has little scientific support and/or minimal health benefit.

What are the symptoms of congestive heart failure? CHF leads to breathlessness, fatigue, and accumulation of fluid in the lungs or the veins (primarily in the legs) or both.

How is it treated? Drug treatments in CHF are often directed at improving the effectiveness of the heart’s contractions. Diuretics may improve function of the heart’s ventricles (muscular pumping chambers). Loop diuretics such as furosemide (Lasix®) and bumetanide (Bumex®), and other diuretics including chlorothiazide (Diuril®) and metolazone (Mykrox®, Zaroxolyn®), are often used. ACE inhibitors also improve heart and blood vessel function as well as exercise tolerance. They include captopril (Capoten®), enalapril (Vasotec®), lisinopril (Prinivil®, Zestril®), and quinapril (Accupril®). Digitalis preparations, most commonly digoxin (Lanoxin®), may be used to improve heart function and reduce the amount of diuretics needed. Drugs may also be used to regulate the heart’s rhythm.

Lifestyle changes that may be helpful: Even with severe disease, appropriate exercise can benefit those with CHF.1 2 In a controlled trial, long-term (one year) exercise training led to improvements in quality of life and functional capacity in people with CHF.3 Nonetheless, too much exercise can be life-threatening for those with CHF. How much is “too much” varies from person to person; therefore, any exercise program undertaken by someone with CHF requires professional supervision.

Non-steroidal anti-inflammatory drugs (NSAIDs) appear to significantly increase the risk of CHF. The use of NSAIDs in one preliminary study was found to double the likelihood of hospital admission with CHF the following week. This likelihood increased by more than 10 times for patients with a history of heart disease.4 This study did not include people taking low-dose aspirin.

Nutritional supplements that may be helpful: People with CHF have insufficient oxygenation of the heart, which can damage the heart muscle. Such damage may be reduced by taking L-carnitine supplements.5 L-carnitine is a natural substance made from the amino acids, lysine and methionine. Levels of L-carnitine are low in people with CHF;6 therefore, many doctors recommend that those with CHF take 500 mg of L-carnitine two to three times per day.

Most L-carnitine/CHF research has used a modified form of the supplement called propionyl-L-carnitine (PC). In one double-blind trial, people using 500 mg of PC per day had a 26% increase in exercise capacity after six months.7 In double-blind research, other indices of heart function have also improved after taking 1 gram of PC twice per day.8 It remains unclear whether propionyl-L-carnitine has unique advantages over L-carnitine, as limited research in animals and humans has also shown very promising effects of the more common L-carnitine.9

Magnesium deficiency frequently occurs in people with CHF, and such a deficiency may lead to heart arrhythmias. Magnesium supplements have reduced the risk of these arrhythmias.10 People with CHF are often given drugs that deplete both magnesium and potassium; a deficiency of either of these minerals may lead to an arrhythmia.11 Many doctors suggest magnesium supplements of 300 mg per day.

Whole fruit and fruit and vegetable juice, which are high in potassium, are also recommended by some doctors; however, this dietary change should be discussed with a healthcare provider, because several drugs given to people with CHF may actually cause retention of potassium, making dietary potassium, even from fruit, dangerous.

Taurine, an amino acid, helps increase the force and effectiveness of heart-muscle contractions. Research (some double-blind) has shown that taurine helps people with CHF.12 13 14 15 Most doctors suggest taking 2 grams three times per day.

As is true for several other heart conditions, coenzyme Q10 (CoQ10) has been reported to help people with CHF,16 sometimes dramatically.17 Positive effects have been confirmed in double-blind research18 and in an overall analysis of eight controlled trials.19 However, some double-blind trials have reported modest20 or no improvement21 22 23 in exercise capacity or overall quality of life. Most CoQ10 research used 90–200 mg per day. The beneficial effects of CoQ10 may not be seen until after several months of treatment. Discontinuation of CoQ10 supplementation in people with CHF has resulted in severe relapses and should only be attempted under the supervision of a doctor.24

The body needs arginine, another amino acid, to make nitric oxide, which increases blood flow. This process is impaired in people with CHF. Arginine supplementation (5.6–12.6 grams per day) has been used successfully in double-blind trials to treat CHF.25 A double-blind trial has also found that arginine supplementation (5 grams three times daily) improves kidney function in people with CHF.26

For people with congestive heart failure, intravenous injections of creatine have been found to improve heart function; oral supplementation has not been effective, though it does improve skeletal muscle function.27 28

In a preliminary study, blood levels of DHEA (dehydroepiandrosterone) were found to be lower in people with CHF than in people without the disease. The lowered blood levels of DHEA among these people was proportional to the severity of their disease.29 However, there is no evidence that DHEA supplementation can prevent or reverse CHF.

Are there any side effects or interactions? Refer to the individual supplement for information about any side effects or interactions.

Herbs that may be helpful: Clinical trials have shown that standardized extracts made from the leaves and flowers of hawthorn are effective in helping people with early-stage CHF.30 31 Hawthorn extracts appear to increase blood flow to the heart, increase the strength of heart contractions, reduce resistance to blood flow in the extremities, and act as an antioxidant.32 33 34 In a large preliminary trial, people with mild to moderate CHF were given 300 mg of hawthorn flower and leaf extract (standardized to contain 2.2% flavonoids) three times a day for two months.35 Symptoms of CHF—including heart palpitations, chest pressure, and swelling in the extremities—decreased throughout the trial during the use of hawthorn. The efficacy of hawthorn for the treatment of CHF has been confirmed in a double-blind trial.36

Hawthorn extracts are available in capsules or tablets standardized to either total flavonoid content (usually 2.2%) or oligomeric procyanidins (usually 18.75%). Doctors who work with herbal medicine often suggest 80–300 mg two to three times per day. Hawthorn berry products that are not standardized may be weaker, and the recommended amount is typically 4 to 6 grams per day for the whole herb, or 4–5 ml of the tincture three times per day.

Coleus contains forskolin, a substance that may help dilate blood vessels and improve the forcefulness with which the heart pumps blood.37 Recent clinical trials indicate that forskolin improves heart function in people with congestive heart failure and cardiomyopathy.38 39 A preliminary trial found that forskolin reduced blood pressure and improved heart function in people with cardiomyopathy. These trials have used intravenous infusions of isolated forskolin. It is unknown whether oral coleus extracts would have the same effect. While many doctors expert in herbal medicine would recommend 200–600 mg per day of a coleus extract containing 10% forskolin, these amounts are extrapolations and have yet to be confirmed by direct clinical research.

A small clinical trial found that supplementation with a bark extract of Arjun (Terminalia arjuna) improved heart function as well as lung congestion in patients with severe CHF.40 Patients in the study took 500 mg of Arjun extract three times per day and began to exhibit significant improvement in heart function within two weeks; improvement continued over the course of approximately two years. The herb extract used in this study was concentrated but not standardized for any particular constituent. Commercial preparations are sometimes standardized to contain 1% arjunolic acid. Larger clinical trials are needed to confirm the results of this small study.

Are there any side effects or interactions? Refer to the individual herb for information about any side effects or interactions.

References:

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2. Oka RK, De Marco T, Haskell WL, et al. Impact of a home-based walking and resistance training program on quality of life in patients with heart failure. Am J Cardiol 2000;85:365–9.

3. Belardinelli R, Georgiou D, Cianci G, Purcaro A. Randomized, controlled trial of long-term moderate exercise training in chronic heart failure. Circulation 1999;99:1173–82.

4. Page J, Henry D. Consumption of NSAIDs and the development of congestive heart failure in elderly patients. Arch Intern Med 2000;160:777–84.

5. Bartels GL, Remme WJ, Pillay M, et al. Effects of L-propionylcarnitine on ischemia-induced myocardial dysfunction in men with angina pectoris. Am J Cardiol 1994;74:125–30.

6. Suzuki Y, Masumura Y, Kobayashi A, et al. Myocardial carnitine deficiency in chronic heart failure. Lancet 1982;i:116 (letter).

7. Mancini M, Rengo F, Lingetti M, et al. Controlled study on the therapeutic efficacy of propionyl-L-carnitine in patients with congestive heart failure. Arzneimittelforschung 1992;42:1101–4.

8. Pucciarelli G, Mastursi M, Latte S, et al. The clinical and hemodynamic effects of propionyl-L-carnitine in the treatment of congestive heart failure. Clin Ther 1992;141:379–84.

9. Kobayashi A, Masumura Y, Yamazaki N. L-carnitine treatment for congestive heart failure—experimental and clinical study. Jpn Circ J 1992;56:86–94.

10. Bashir Y, Sneddon JF, Staunton A, et al. Effects of long-term oral magnesium chloride replacement in congestive heart failure secondary to coronary artery disease. Am J Cardiol 1993;72:1156–62.

11. Packer M, Gottlieb SS, Kessler PD. Hormone-electrolyte interactions in the pathogenesis of lethal cardiac arrhythmias in patients with congestive heart failure. Am J Med 1986;80 (Suppl 4A):23–9.

12. Azuma J, Sawamura A, Awata N, et al. Double-blind randomized crossover trial of taurine in congestive heart failure. Curr Ther Res 1983;34(4):543–57.

13. Azuma J, Hasegawa H, Sawamura N, et al. Taurine for treatment of congestive heart failure. Int J Cardiol 1982;2:303–4.

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16. Mortensen SA, Vadhanavikit S, Baandrup U, Folkers K. Long-term coenzyme Q10 therapy: a major advance in the management of resistant myocardial failure. Drug Exptl Clin Res 1985;11:581–93.

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20. Hofman-Bang C, Rehnqvist N, Swedberg K, et al. Coenzyme Q10 as an adjunctive in the treatment of chronic congestive heart failure. The Q10 Study Group. J Card Fail 1995;1:101–7.

21. Permanetter B, Rossy W, Klein G, et al. Ubiquinone (coenzyme Q10) in the long-term treatment of idiopathic dilated cardiomyopathy. Eur Heart J 1992;13:1528–33.

22. Watson PS, Scalia GM, Galbraith A, et al. Lack of effect of coenzyme Q on left ventricular function in patients with congestive heart failure. J Am Coll Cardiol 1999;33:1549–52.

23. Khatta M, Alexander BS, Krichten CM, et al. The effect of coenzyme Q10 in patients with congestive heart failure. Ann Intern Med 2000;132:636–40.

24. Mortensen SA, Vadhanavikit S, Baandrup U, Folkers K. Long-term coenzyme Q10 therapy: a major advance in the management of resistant myocardial failure. Drug Exptl Clin Res 1985;11:581–93.

25. Rector TS, Bank A, Mullen KA, et al. Randomized, double-blind, placebo controlled study of supplemental oral L-arginine in patients with heart failure. Circulation 1996;93:2135–41.

26. Watanabe G, Tomiyama H, Doba N. Effects of oral administration of L-arginine on renal function in patients with heart failure. J Hypertens 2000;18:229–34.

27. Andrews R, Greenhaff P, Curtis S, et al. The effect of dietary creatine supplementation on skeletal muscle metabolism in congestive heart failure. Eur Heart J 1998;19:617–22.

28. Gordon A, Hultman E, Kaijser L, et al. Creatine supplementation in chronic heart failure increases skeletal muscle creatine phosphate and muscle performance. Cardiovasc Res 1995;30:413–8.

29. Moriyama Y, Yasue H, Yoshimura M, et al. The plasma levels of dehydroepiandrosterone sulfate are decreased in patients with chronic heart failure in proportion to the severity. J Clin Endocrinol Metab 2000;85:1834–40.

30. Leuchtgens H. Crataegus special extract (WS 1442) in cardiac insufficiency. Fortschr Med 1993;111:352–4.

31. Schmidt U, Kuhn U, Ploch M, Hübner WD. Efficacy of the hawthorn (Crataegus) preparation LI 132 in 78 patients with chronic congestive heart failure defined as NYHA functional class II. Phytomed 1994;1:17–24.

32. Maevers VW, Hensel H. Changes in local myocardial blood flow following oral administration of a Crataegus extract to non-anesthetized dogs. Arzneimittelforschung 1974;24:783–5.

33. Weikl A, Noh HS. The influence of Crataegus on global cardiac insufficiency. Herz Gerfässe 1992; 11:516–24.

34. Bahorun T, Trotin F, Pommery J, et al. Antioxidant activities of Crataegus monogyna extracts. Planta Med 1994; 60:323–8.

35. Schmidt U, Albrecht H, Podzuweit M, et al. High-dose crataegus therapy in patients suffering from congestive heart failure NYHA class I and II. Z Phytotherapie 1998;19:22–30.

36. Rietbrock N, Hamel M, Hempel B, et al. Actions of standardized extract of Crataegus berries on exercise tolerance and quality of life in patients with congestive heart failure [in German]. Arzneimittelforschung 2001;51:793–8.

37. Lindner E, Dohadwalla AN, Bhattacharya BK. Positive inotropic and blood pressure lowering activity of a diterpene derivative isolated from Coleus forskohli: Forskolin. Arzneimittelforschung. 1978;28:284–9.

38. Baumann G, Felix S, Sattelberger U, Klein G. Cardiovascular effects of forskolin (HL 362) in patients with idiopathic congestive cardiomyopathy—a comparative study with dobutamine and sodium nitroprusside. J Cardiovasc Pharmacol 1990;16:93–100.

39. Kramer W, Thormann J, Kindler M, Schlepper M. Effects of forskolin on left ventricular function in dilated cardiomyopathy. Arzneimittelforschung 1987;37:364–7.

40. Bharani A, Ganguly A, Bhargava KD. Salutary effect of Terminalia Arjuna in patients with severe refractory heart failure. Int J Cardiol 1995;49:191–9.