The heart and the kidneys work very closely together, which means that if there is a problem in one organ, it can end up causing problems in the other. Because of this, people with kidney disease have a higher risk of developing heart failure. For this reason, I thought we’d have a look at what heart failure is and go through some tips for prevention and management.
First things first:
What is heart failure?
Heart failure is a condition in which the heart can’t pump enough blood to meet the body’s needs. Heart failure develops over time as the heart’s pumping action grows weaker. In some cases, the heart can’t fill with enough blood while in other cases, the heart can’t pump blood to the rest of the body with enough force. Some people have both problems.
The term ‘heart failure’ can be frightening. It doesn’t mean the heart has ‘failed’ or stopped working. It means the heart doesn’t pump as well as it should.
At first the heart tries to make up for this by:
- Enlarging- the heart stretches to contract more strongly and keep up with the demand to pump more blood. Over time this causes the heart to become enlarged.
- Developing more muscle mass- the increase in muscle mass occurs because the contracting cells of the heart get bigger. This lets the heart pump more strongly, at least initially.
- Pumping faster- this helps increase the heart’s output.
Eventually the heart and body just can’t keep up, and the person experiences various symptoms. Just like in kidney disease, the body’s compensation mechanisms help explain why some people may not be aware of their condition until years after their heart begins its decline.
Risk factors for heart failure
Heart failure often develops after other conditions have damaged or weakened your heart. However, the heart doesn’t have to be weakened to cause heart failure. It can also occur if the heart becomes too stiff.
Risk factors for developing heart failure include:
- High blood pressure
- Coronary artery disease
- Kidney disease
- Heart attack
- Sleep apnoea
- Congenital heart defects
- Valvular heart disease
- Heart arrhythmias
- Alcohol use
- Tobacco use
- Certain medications
- Treatments for cancer such as radiation and certain chemotherapies
As you can see, many of these risk factors can be modified so there’s plenty you can do to reduce the risk of developing heart failure and reduce the progression of heart failure.
Signs and Symptoms of heart failure
- New or worsening shortness of breath (particularly during physical activity and when lying down at night)
- Swelling of ankles, legs or abdomen
- Rapid weight gain (from fluid)
- Reduced ability to exercise
- Persistent cough or wheeze with white or pink blood-tinged phlegm
- Increased need to urinate at night
Types of heart failure
- Left-sided heart failure– there are two types of left-sided heart failure:
Heart failure with reduced ejection fraction (HF-rEF) also called systolic failure: the left ventricle loses its ability to contract normally. The heart can’t pump with enough force to push enough blood into circulation.
Heart failure with preserved ejection fraction (HF-pEF) also called diastolic failure (or diastolic dysfunction): the left ventricle loses its ability to relax normally because the muscle has become stiff. The heart can’t properly fill with blood during the resting period between each beat.
- Right-sided heart failure– usually occurs as a result of left sided failure. When the left ventricle fails, increased fluid pressure is transferred back through the lungs, ultimately damaging the heart’s right side. When the right side loses pumping power, blood backs up in the body’s veins. This usually causes swelling or congestion in the legs, ankles and swelling within the abdomen such as the GI tract and liver.
- Congestive heart failure (CHF) also called Congestive cardiac failure (CCF)- as blood flow out of the heart slows, blood returning to the heart through the veins backs up, causing congestion in the body’s tissues. Often swelling (oedema) results. Most often there’s swelling in the legs and ankles, but it can happen in other parts of the body too.
There are 4 stages of heart failure- stage A, B, C and D- which range from ‘high risk of developing heart failure’ to ‘advanced heart failure’.
Stage A is considered pre-heart failure. It means you are at high risk of developing heart failure because you have a family history of heart failure or you have one or more of these medical conditions:
- High blood pressure
- Coronary artery disease
- Metabolic syndrome
- Family history of cardiomyopathy
- History of rheumatic fever
- History of alcohol abuse
- History of taking drugs that can damage the heart muscle, such as some cancer drugs
Stage B is considered to be asymptomatic or silent heart failure. It means you have a structural or functional abnormality of the heart but have never had symptoms of heart failure.
Patients with stage C heart failure have been diagnosed with heart failure and have (currently) or had (previously) signs and symptoms.
Patients with stage D have advanced symptoms that occur on mild or minimal exertion or at rest.
But what does heart failure have to do with kidney disease?
Well, the heart and the kidneys work very closely together, which means that if there is a problem in one organ, it can end up causing problems in the other. People with CKD have a higher risk of heart failure because the kidneys can’t get rid of fluid effectively. In turn, people with heart failure have a higher risk of CKD due to reduced blood flow to the kidneys.
The heart’s job is to send a continuous supply of oxygenated blood around the body. The kidneys filter the blood, extracting waste in the form of urine, and also helps regulate the water and salt levels to control blood pressure.
Relatively recent research has shown that heart failure is a significant risk factor for kidney disease. When the heart is no longer pumping efficiently it becomes congested with blood, causing pressure to build up in the main vein connected to the kidneys and leading to congestion of blood in the kidneys, too. The kidneys also suffer from the reduced supply of oxygenated blood.
When the kidneys become impaired, the hormone system, which regulates blood pressure, goes into overdrive in an attempt to increase blood supply to the kidneys. The heart then has to pump against higher pressure in the arteries, and eventually suffers from the increase in workload.
Prevention and Management of heart failure
As we all know, prevention is always better than cure and while some of the risk factors for developing heart failure can’t be prevented (like getting older!), many of them can be prevented or controlled.
As I already mentioned, having kidney disease increases your risk of developing heart failure so being aware of the symptoms of heart failure is really important and discussing these with your doctor if they occur to allow for a proper and early assessment of your heart function.
Diet and Lifestyle interventions:
- Avoid alcohol, tobacco and recreational drugs
- Maintain a healthy weight
- Maintain healthy cholesterol levels
- Manage blood glucose levels
- Manage blood pressure
- Restrict salt in your diet
- Avoid caffeine- caffeine has been shown to have a detrimental effect on arterial stiffness and is a risk factor for heart failure.
- Get enough sleep
- Graded exercise- It may be useful to see an exercise physiologist or physiotherapist to assist in designing a personalised exercise program for you.
- Avoid red meat
- Actively manage stress- whether that be using breathing exercises, yoga, tai chi, meditation, time spent in nature, journaling, creative activities.
- Avoid nonsteroidal anti-inflammatory drugs
- Eat an alkaline diet high in anti-inflammatory foods and antioxidants
- Increase intake of fatty fish- higher fish intake is associated with reduced risk for heart failure.
- Hawthorn (Crataegus monogyna)- reviews of placebo-controlled trials have reported both subjective and objective improvement in patients with heart failure. Hawthorn has anti-arrhythmic effects, increases blood flow to the heart and increases cardiac output.
- Dan Shen (Salvia miltiorrhiza)- has many beneficial effects on the heart, can protect the heart against acute ischaemic injury and helps to reduce many of the risk factors for heart failure including high blood pressure, arrhythmias, hardening of the arteries, heart attack and shows favourable effects on protecting against cardiac hypertrophy (enlargement or thickening of heart) and cardiac fibrosis (scarring).
- Astragalus (Astragalus membranaceus)- studies show Astragalus improved heart function, reduced symptoms and improved quality of life in people with heart failure. It also reduces some of the risk factors for developing heart failure and has diuretic properties which can take some of the extra work load off the heart in heart failure.
- Coenzyme Q10– has long been used as a nutritional supplement for cardiovascular disease and has a supportive role in heart failure. Studies show beneficial effects on ejection fraction, reduced development of fluid on the lungs, reduced hospitalisation rates and improved symptoms.
- L-Carnitine– studies show it is effective for heart failure patients in improving symptoms and cardiac function and decreasing levels of BNP (brain natriuretic peptide).
- Magnesium– magnesium deficiency is more common in people with heart failure and is associated with worse outcomes.
- Omega-3 fatty acids (eg. Fish Oil)- increased EPA/DHA intake has been shown to prevent heart failure from developing and reduce the risk of hospitalisation for cardiovascular reasons and improve ejection fraction in people with heart failure.
- Vitamin D– vitamin D deficiency is associated with increased risk of heart failure and severe vitamin D deficiency was associated with a higher risk of death from heart failure.
- B vitamins– B vitamins are important due to their multiple functions in the body, including energy production, particularly for the heart. Hospitalised patients with heart failure have been found to be deficient in several B vitamins.
Make sure you consult your health care practitioner before starting any new supplements especially if you are taking any pharmaceutical medications to ensure they are appropriate for you.
So there you go, a breakdown of what heart failure is, risk factors for developing heart failure, signs and symptoms to be aware of and the link between heart failure and kidney disease and most importantly some key considerations when it comes to using natural medicine for preventing and managing heart failure.
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