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Heart Failure Is No Longer a 'Death Pill' 



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Heart failure sounds immediate and total -- like power failure. But heart failure -- often called congestive heart failure -- doesn't mean the heart suddenly stops. The term for that is cardiac arrest. Rather, it means that the heart can't pump enough blood to meet the body's needs because one or both ventricles (the heart's main pumping chambers) are not functioning properly. In many cases, they can't pump with enough force (systolic heart failure). In others, the problem is an inability to draw enough blood in (diastolic heart failure). Often the weakened heart is also contending with constricted arteries and veins, so it must work that much harder to push blood through the circulatory system. 

The hallmark symptoms are shortness of breath (dyspnea), fatigue, swelling in the extremities (peripheral edema), and collection of fluid around the lungs (pleural effusion). 

Heart failure often occurs in the aftermath of other heart and vascular problems, so there are both causes and consequences to deal with. The conditions that can lead to heart failure include coronary artery disease (blockage of arteries supplying blood to heart muscle), high blood pressure and heart valve defects. 

Medications
Just 25 years ago, there were only two main classes of medications for the treatment of heart failure: diuretics (water pills) and digitalis (digoxin). Diuretics rid the body of excess fluid by increasing urine flow. Digitalis, originally derived from the purple foxglove plant (Digitalis purpurea), has been used for treating heart disease since the 18th century. It widens blood vessels and increases the force of the heartbeat. Although both drugs relieve symptoms, they don't have much impact on the death rate from heart failure. 



Now, myriad drugs are used for heart failure. Of all the ones that have come into use over the past couple of decades, the angiotensin-converting-enzyme (ACE) inhibitors are the most important. They're the single biggest reason why heart failure has become a treatable condition rather than a death sentence. ACE inhibitors work by blocking the synthesis of angiotensin, a substance that constricts blood vessels, raises blood pressure, and puts strain on the heart. As a result, they slow the deterioration of the straining heart muscle. 

Angiotensin-receptor blockers (ARBs) are an alternative for patients who can't tolerate the side effects of ACE inhibitors. Like ACE inhibitors, they interfere with angiotensin, but in a different way. It's not clear that they are as effective as ACE inhibitors, but they are much less likely to cause the dry cough some people get from an ACE inhibitor. 

Aldosterone, a hormone produced by the adrenal glands, increases blood volume and raises blood pressure. High levels of the hormone can damage heart muscle, causing it to become enlarged and develop stiff, fibrous tissue (cardiac fibrosis). Aldosterone antagonists, or blockers, counteract this effect, and also prod the kidneys to eliminate unneeded water and salt. Side effects can be a problem with spironolactone (Aldactone), the most widely used aldosterone antagonist. Eplerenone (Inspra), first approved by the FDA in 2002 for high blood pressure, is an alternative that seems to cause fewer side effects. 

Beta blockers interfere with the action of adrenaline and related compounds. They reduce high blood pressure, help correct irregular heartbeats, and reduce the heart's workload. At first, doctors thought beta blockers might actually worsen heart failure and avoided prescribing them. Why slow down a weakened heart? But during the past 10 years, researchers discovered that if heart failure patients took ACE inhibitors and beta blockers together, they lived longer. 

As its pumping action becomes floppy and inefficient, a diseased ventricle leaves more blood behind, where it can pool in the heart chambers and form a clot, which could travel to the brain and cause a stroke. Anticoagulants, such as warfarin (Coumadin), are prescribed to prevent that. 

Nesiritide (Natrecor) is a powerful intravenous drug that relaxes blood vessels and helps make the heart beat stronger. It was originally intended only for heart failure patients who were very ill (decompensated), but doctors started to prescribe serial infusions for patients after they left the hospital. After two studies raised questions about its safety, a panel of cardiologists chaired by Harvard Medical School's Dr. Eugene Braunwald said it shouldn't be used that way and recommended strictly limiting the drug to seriously ill patients arriving at the hospital. At the same time, the panel said a clinical trial in outpatients should continue. 

Especially in the beginning, heart failure can often be well-controlled with an ACE inhibitor and a beta blocker in combination with exercise, diet and other lifestyle changes. Often, though, in more advanced cases, the drug regimen gets complicated. It's not uncommon for a patient with heart failure to be taking an ACE inhibitor, a so-called loop diuretic (Bumex, Lasix), digoxin (Lanoxin), an aldosterone antagonist (spironolactone or eplerenone), and a beta blocker. 

These combinations do wonders, both relieving the symptoms of patients and helping them live longer. But as the mix becomes more complex, so does the tinkering and adjustment needed to get the desired effect. Interactions among drugs can be a problem. Doctors really need to know what they're doing -- and know their patients. Needless to say, more drugs means more expense, both because newer medicines usually cost more and because complicated drug schedules require more doctors' appointments and lab tests. 

cardiopulmonary exercise Cardiopulmonary exercise testing involves submaximal and maximal treadmill or bicycle exercise with continuous electrocardiographic monitoring and breath by breath determination of oxygen uptake and carbon dioxide output as well as spirometry. This allows determination of exercise capacity, peak heart rate, maximal oxygen consumption, anaerobic threshold, respiratory gas exchange ratio, and ventilatory equivalent for oxygen. Maximal oxygen consumption is the best indicator of maximal cardiac reserve and provides important prognostic information to guide the assessment and therapy of patients with heart failure as well as other cardiac conditions. The truth is, cholesterol is only one of the potential causes of heart disease and even that's a stretch if you ask me. So, you can run six miles a day, eat oat-bran for breakfast, lunch and dinner and suck down your statins if you want to...but isn't that what everyone else is already doing? Then why are roughly 50% of all Americans still struggling with heart disease? I'm not much of a statistics guy, but it's true: every other person you know is likely to die of heart disease. However, my friend, you don't have worry about being a statistic because, I have a plan. But in order to defeat your enemy, first you must know your enemy Mysterious Cause of Heart Disease Discovered Have you heard the latest news reports identifying a mysterious cause of heart disease? Well, if you've been reading my newsletter, then you know heart disease has been linked to bacterial infections! No, this isn't just my personal opinion. Even the more prominent mainstream doctors are now pointing to infections like Chlamydia pneumoniae (C. pneumoniae) as a factor in heart disease. Yes, it is now widely recognized that infections, like C. pneumoniae, can trigger the formation of vulnerable plaque, causing heart disease. In fact, for men with the highest risk factors, heart attacks can be prevented by antibiotics in up to 55% of cases! How about a $50,000 bypass surgery? Sure, your doctor would love to sell you one of those. But at $50,000 a pop, chances are your doctor isn't going to risk losing the sale by telling you that there isn't a single study on the books to prove that bypass surgery works any better than other medical therapies. In fact, a 1984 study showed that after 11 years there was no difference between bypass and nonbypass patients. ell, how about a little roto-rootering angioplasty then? It s slightly less invasive... maybe a little less expensive...and it's certainly safer, right? Wrong. There's a very real danger of the affected artery rupturing during the course of the procedure in which case, you re in for emergency b pass surgery anyhow!  As usual, the experts are great at identifying the problem. Now, if only they could discover a simple, safe, affordable solution. Well, here's a brainstorm...if we know that bacterial infections can trigger plaque formation and ultimately lead to heart disease, then why not simply eliminate those bacteria? Heart Disease Cause #2: Free-Radical Damage The experts want you to believe that cholesterol is your archenemy. Apparently, they were asleep during Biology 101 when the professor explained that your body more specifically, your liver actually produces cholesterol naturally to convert into hormones. Although, the cholesterol hypothesis is handy for one thing: Selling over-priced statin drugs. The real truth lies deeper than that shallow money-making myth.  You see, the plaque in your arteries isn't made up of naturally occurring cholesterol. It s made up of a special kind of cholesterol: Damaged, oxidized cholesterol! Free radicals steal electrons from your cholesterol. Let's see, if oxidized cholesterol is a cause of heart disease, then the solution must be statins, right?  Wrong! The way to keep free radicals from damaging your cholesterol is to zap them with antioxidants! And, I've identified the one 'mother antioxidant' that synergistically extends and renews the others, making them more effective.The All-Natural Answer For Real Heart Health There's a new heart care revolution gaining momentum, and you re one of the first people this amazing 300-year-old remedy is being revealed to long before the herd finally discovers it when it appears on the cover of Newsweek decades from now.Medical science has discovered a remarkable nutrient your heart tissues are craving called, Terminalia arjuna. Just this one heart-healing nutrient alone has been proven to:

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