Heart Failure Herbal Remedies

Heart Failure

Clinical Considerations

➤General comments
– In heart failure, the heart is unable to maintain adequate circulation owing to a decrease in heart muscle function (cardiac output) resulting from cardiac myocyte death. The main causes are hypertension  with increased venous pressures or cardiac volumes, valvular defects, and ischemia due to sclerotic coronary artery disease.
– The body attempts to compensate for the circulatory deficiency by stimulating mechanisms such as the sympathetic nervous system and by narrowing the blood vessels, resulting in a higher workload on the heart. Additional compensatory mechanisms lead to a further decrease in cardiac performance.
– Effective treatment measures should be initiated as early as possible to prevent the progression of heart failure.

➤ Prognosis:
The overall prognosis for heart failure remains poor although the conventional treatments (diuretics, ACE inhibitors, beta blockers, AT 1
-blockers, digitalis) are effective.

➤Classification:
According to the system of the New York Heart Association (NYHA), heart failure is divided into four clinical stages:
– NYHA I: Symptoms do not occur during normal physical exercise.
– NYHA II: Symptoms occur during more strenuous exercise.
– NYHA III: Symptoms occur during light exercise.
– NYHA IV: Symptoms occur even at rest.

➤ Clinical value of herbal medicine:
Hawthorn and digitaloid herbs are used in NYHA I and II heart failure. The current knowledge does not support treatment of NYHA III and IV heart failure by herbal remedies.

Recommended Herbal Remedies
Flavonoid-containing Herbs

➤Hawthorn leaf and flower
(Crataegie folium cum flore;).
–Action: Procyanidins enhance the influx of calcium into cardiac muscle fibers while only moderately increasing the oxygen demand. These compounds widen the coronary arteries and other cardiac vessels, thereby extending the refractory time. This results in an antiarrhythmic effect.
– Advantages of hawthorn
•Effective and well-tolerated in the early stages of heart failure, especially in patients with age-related degenerative changes in the heart muscle.
•With a high rate of acceptance by patients, hawthorn leaf and flower have only few side effects.
•Since flavonoids do not reduce the afterload, hawthorn can also be used by patients with low blood pressure.
•Hawthorn can be recommended for long-term use, and it combines well with cardiac glycosides, but may have a synergistic effect. This potential interaction should be watched. It may allow a reduction in medications like digoxin while maintaining the same overall therapeutic effect.
–Dosage and administration: One oral dose, 2 to 3 times daily. Relatively large doses over time are needed for sufficient effects. A daily dose of ca. 900 mg hawthorn total extract is generally recommended. The herbal remedy takes around 4 weeks to become fully effective.

Note:
Tea infusion is not the best way to extract water-soluble compounds from hawthorn. Hawthorn tea therefore has only weak effects and can be recommended, at best, only for a health-promoting effect in the very early stages of cardiac insufficiency, or as a long-term preventative measure.

Digitaloid Herbs

➤Adonis
(Adonidis herba;), lily-of-the-valley (Convallariae herba;), and squill root (Scillae bulbus;).

–Action: The effects are comparable to those of the isolated substances digoxin and digitoxin, but the herbal preparations have secondary effects such as increased urinary excretion (squill) or frequency (lily-of-the-valley).
–Advantages: The herbal preparations have a somewhat wider therapeuticrange than the isolated substances, but their concentrations can extend into the toxic range.
–Disadvantages: The absorption of the active compounds in the herbal preparations is generally poor and variable. Hence, their bioavailabilities and potencies are usually low.
–Dosage and administration: One oral dose, 2 to 3 times daily. Individualized dose setting is required.

Warning:All digitaloid preparations can be toxic (similar to the glycosides digoxin and digitoxin), producing symptoms such as nausea, vomiting, stomach complaints, diarrhea, and cardiac arrhythmias.

Combinations of Flavonoid and Digitaloid Herbs
–Advantages:The tolerance is said to be better than that of preparations containingdigitaloid herbs alone.
–Disadvantages:Their therapeutic range is smaller than that of pure hawthorn preparations, and their toxic effects are similar to those of digitaloiddrugs. 4.1 Heart Failure

Posted in: Cardiovascular Diseases Herbal Remedies