Fratellone Medical Associates

Congestive Heart Failure Medical Treatment Center in NYC

As you know, congestive heart failure (CHF) affects 5 million Americans every year.
CHF means failure of the heart muscle. The heart becomes literally congested with blood and dangerously weakened. The most common cause of heart failure is coronary occlusion, although valvular heart disease, especially mitral regurgitation, can cause CHF.

In regard to a coronary occlusion, when a large area of muscle is “killed” through a large
myocardial infarction or small repeated attacks, there is not enough heart muscle left to pump the blood out of the left ventricle. The pressure and volume of blood inside the heart’s pumping chamber build up, putting additional pressure on arteries and veins in the lungs. Thus this fluid leaks into the lungs causing the congestive heart failure process to begin.

A typical sign of CHF is shortness of breath either with minimal exertion or lying down at night. Other symptoms can be palpitations, and severe fatigue. As the heart muscle weakens, the pump function or ejection fraction decreases.

There are multiple conventional medications, through clinical trials, that have proven to be effective in treating heart failure. In addition to these medications, we utilize NT factor.

The onset of heart disease correlates with the accumulation of oxidative damage in the cardiac muscle cell membranes. This accumulation of oxidative damage decreases energy production in the cardiac cells. This is referred to as “energy starvation”. NT factor fixes the energy starvation because it restores mitochondrial function. In clinical studies it has been shown to restore a person’s energy. NT factor is a nutrient compound composed of food and food extracts of phosphoglycolipids, pre and probiotics. It addition to sustaining the mitochondrial membrane, it also maintains a healthy flora in the large intestines.A component of CVD is high blood pressure, hypertension (HTN). The classification of hypertension has changed over the years based on medical classification JNC. It will soon change again according to JNC VIII. Most of us know that when taking the blood pressure with a cuff, there is a top number and a bottom number, systolic and diastolic respectively. The systolic blood pressure measures the contraction of the heart during the systolic phase while the diastolic blod pressure is when the heart is relaxing. Blood pressure differs from individual to individual, from morning to evening, from rest to exercise and from sitting to standing. Blood pressure should be taken in both arms in a sitting, standing and lying position. In the past, if the diastolic number was 100, it was considered hypertension. Then the number was lowered to 90 mmHg diastolic and now, in 2010, it is 85 mmHg.

As we change the guidelines, more and more people have hypertension. Doctors should be in the practice of preventive care, not only during treatment when the disease entity has already occurred. Preventive care for HTN does fit the 7 lifestyle pyramid I am trying to teach. It involves a dietary lifestyle change as well as an exercise change. Number studies have concluded that a better diet rich in vegetables/fruits will decrease blood pressure. Exercise goes without discussing (until the blog turns to one month of exercise blogging). Both addictions and meditation can effect blood presure. Unfortunately, addictions such as smoking, drinking, coffee and use of illicit drugs adversely affect HTN whereas an addiction to yoga would benefit blood pressure. Meditation has been proven to be an effective measure to decrease HTN. This is one of the relaxation techniques. Acupunture and massage therapy also can be effective. The fifth lifestyle change of self-esteem can decrease blood pressure. This involves finding a hobby. This blog for me not only relaxes me but allows me, for better or worse, to show you my hobbyy. For those of you that are new, needle craft is my hobby. Anger and resentment, the sixth lifestyle change is most often overlooked. Any anger and resentment will lead to our body becoming toxic. It can cause a variety of disease from cardiovasular disease (CVD) to cancer. And finally, self-love is the premier of all lifestyle changes. I know you have heard this over and over again. It never hurts to hear it again.
Even though as stated before that the number of heart attacks have been reduced due to technology and awareness, I did state that the number of patients with heart failure has increased. I do not think the medical community, cardiologists particularly understand the treatment. The causes of congestive heart failure (CHF) are numerous–coronary artery disease, valvular, and enlargement of the heart ( cardiomyopathy- due to alcohol,viruses and heavy metals) . It causes a weakened heart muscle. The conventional drugs are used because they do work. These can be amniotes converting inhibitors (ACE), beta blockers, diuretics, and even the beloved foxglove (digitalis) Conventional physicians should be open to powerful nutritional support as Coenzyme Q 10, L-carnitine and D-ribose. This is nutrition directed at the cellular level.

L -CARNITINE
It is derived from two amino acids–lysine and methionine. To get to carnitine the body needs co factors to help it along. These co factors are other vitamins as Vitamin C, niacin and B6. Amino acids are the building block of proteins, therefore a pure vegetarian will have low levels of L-carnitine. In the diet the greatest source of carnitine is therefore from meat. I am not advocating eating animal meat. If you read the ‘Omnivore Dilemma’ by Michael Pollan you can understand why you wouldn’t touch a piece of red meat. Those of you who are purists, need to supplement your L-carnitine.
The asparagus isn’t going to do it at 0.08 mm/g carnitine versus beef or lamb at levels of 3.80 – 4.80 mm/g carnitine. So you say I eat beans ! Yes that is protein but beans lack methionine even though they contain lysine, so there will be little L-carnitine. You need both of those amino acids to form L-carnitine. So you could supplement both amino acids, yet isn’t it easier just to take L-carnitine.

A pure vegetarian from childhood will develop muscle weakness and even failure to thrive. If you are a vegetarian, just simply supplement your carnitine. Those cancer patients who have tried a strict macrobiotic diet need to supplement L-carnitine. Carnitine is produced (or made) on a cellular level and exerts its effects on a cellular level. Let’s make this easier. It helps with the production of energy. In the body , this is in the form of ATP. ATP is made in every single cell. Every cell has a organelle that produces the energy. This powerhouse of the cell is called the mitochondria. So a major role of L-carnitine is to assist in the making of ATP within the mitochondria. Other roles include ridding the body of toxins ( example, lactic acid and detoxifying ammonia), and acting as an antioxidant. L-carnitine is a free radical scavenger. Free radicals cause disease, so L-carnitine is the vacuum cleaner of the free radicals.

The major deficiency in L-carnitine results in muscle deficiency. Studies have shown benefit in exercise tolerance with as low as 900 mg of l-carnitine. I usually give upwards of 2,500 mg of L-carnitine for most of my cardiac patients. There even as been a reduction in extra ectopic ventricular beats in patients using L-carnitine versus the group that didn’t use L-carnitine. I do not understand why conventional cardiologists do not use L-carnitine. Many of these studies have been published in peer review journals, as Circulation and Journal of the American College of Cardiology. There are smaller studies in the benefit of L-carnitine for CHF. These studies are smaller groups as compared to the large European studies. Those with CHF using L-carnitine did have benefit, but I feel more studies need to be done. There are even studies using L-carnitine in those patients with peripheral artery disease who have intermittent claudication ( squeezing of their legs when the patients walk. The data does show that L-carnitine supplementation has been used for the prevention and treatment of a wide variety of cardiovascular condition.

D-RIBOSE
It is a simple sugar, D-ribose, a monosaccharide. D – ribose was first reported in 1891 by Emil Fischer. D-ribsoe in the past years has been marketed as a supplement for bodybuilders with a common dose being 5 g.( or 5,000 mg) There are conflicting studies. While some state that they found increase exercise endurance and recovery, there are others who have found no benefit. I know some clinics that prescribe using 5 grams upwards for the treatment of fatigue in Chronic Fatigue Syndrome (CFS) Fibromyalgia and CHF When the heart muscle has a sudden drop in flow either by partial or complete obstruction, there is a decrease in energy production. This energy is ATP. D-ribose is the natural ingredient for building more ATP. Thus some feel that D-ribose can rejuvenate the heart muscle. There was a landmark study where D-ribose was given during surgery and the results were dramatic in a positive way. These studies have proved that D-ribose has a pwoerful protective effect for the heart especially under the most stressful coniditons as a heart attack ( myocardial infarction) or partial blockage of a coronary artery ( ischemia and/or angina) After D-ribose supplementation, the heart muscle pain and fatigue is reduced. This supplement can lead to better delivery of oxygen rich blood to an area that is deprived or depleted of oxygen. Other studies have used D -ribose for hypertension, and congestive heart failure. I

HERBS
For the treatment of her heart failure due to her organic valve disease, a plant should be considered. Not any plant, but the Foxglove. This is also known as Digitalis or Digoxin. The latin name is Digitalis purpurea. Digitalis is a cardiac glycoside. there are other plants that have simnilar properties to digitalis, but not as effective. Why would we search the plant kingdom for another ‘digitalis’ like drug, when this one works just fine. We must thank William Withering.

Some formation about Dr.WW. Withering was born in Wellington, Shropshire, trained as a physician and studied at the University of Edinburgh. He worked at Birmingham General Hospital from 1779. I did 8 months in the Black Country where the Birmingham General Hospital is located. I did some of my medical training in Dudley,and Kingswinford in the same geographical area. The story is that he noticed a person with dropsy (swelling from congestive heart failure) improve remarkably after taking a traditional herbal remedy; Withering became famous for recognising that the active ingredient in the mixture came from the foxglove plant.The active ingredient is now known as digitalis, after the plant’s scientific name. In 1785, Withering published An Account of the Foxglove and some of its Medical Uses, which contained reports on clinical trials and notes on digitalis’s effects and toxicity. His clinical skills were excellent. He described digitalis toxicity as we know today. He noted the toxic effects of vomiting, diarrhea, visual disturbances with a green and yellow hue, and seizures. We do know that foxglove grown in the wild has the best medicinal properties. There is another form of foxglove. This is Woolly or Austrian Foxglove. Its latin name is Digitalis lanata. The only advantage I can find where lanta is better than purpurea, is that lanata can be cultivated on a much larger scale.
I find that the most interesting property of this herb is that it can restore a weakened heart to a stronger better functioning heart. During my clinical clerkship years in England, I used more digitalis than when I returned to the United States. When I was in cardiology training the use of digitalis started to wax and wane. At one point with the technological advance in other medications for heart failure–digitalis use basically ceased. I started to use it again about 6-7 years ago.

Foxglove ( Digitalis purpurea) is one of the loveliest, most important plant species that has been introduced from Europe and naturalized in various parts of North America. The foxglove is a member of the Figwort Family. The name is the Scrophulariaceae. It does grow in the woods and mountains in Europe. The flowers are numerous, on a spike, and range from a deep purple to lilac with conspicuous spots interlining the throat of the tubular flower. As a biennial, the leaves form a rosette the first year followed by the flower spike the next year. Prefers a nitrogen-rich sandy loam soil, in partial sun to full shade.

Digoxin (Digitalin) is a drug that is extracted from Digitalis lanata.This is the Woolly or Austrian Foxglove. Upon reading about this foxglove, I see it has a different family. I must ask my professor in two weeks about this Family change. It is used to treat some heart conditions such as congestive heart failure. It has a tonic effect on heart disease enabling the Digitalin was not discovered until the mid 1800s by two French scientists Homolle Ouevenne and Theodore Ouevenne.

Although foxglove exerts its effects in heart failure by increasing the contractility in a positive way, it also can be used for cardiac rhythm abnormalities, aka cardiac arrhythmia’s . It is most commonly used to slow the heart rate for those individuals in an irregular, irregular rhythm called at rial fibrillation.

Millions of people have HTN. It is the usual medical practice to start the patient on a medication without even discussing dietary and exercise regimens. Your physician can give you a prescription for dietary changes and an exercise prescription. I do utilize conventional blood pressure medications but I also include dietary changes, supplementation with vitamins and nutrients as well as herbal therapies. I educate the patient.

Our approach at Fratellone Medical Treatment Center is to provide our patients for extensive ongoing conventional medical care, while providing the most effective integration with alternative treatments.