Congestive Heart Failure

lacie001 said:

I would appreciate any help or insight the physicians on this board could provide.

My father, a 60 year old male, was diagnosed with congestive heart failure 7 years ago. He went in
for an angioplasty with stent placement and ended up in an emergency quadruple bypass. At the
time, given the circumstances, he was given a 50/50 chance of living. He is a fighter and came
back from the bypass and returned to work in only 3 weeks.

Last night we were talking and he asked me to keep a secret for him. He told me that his doctor
told him 3 weeks ago that he had 6 to 18 months to live due to the CHF. He has been on a protocol
of diuretics, cholesterol reducers and heart medications for the last 7 years. He was told he has
approximately 30% of his heart muscle left. Obviously this really shook me up and I've been
searching for answers. He says he feels great, in fact better than he had prior to the bypass.

I know I have not provided all the information necessary, but is there anything that can be done?

Yes.

Quoted message said:

Based on my conversation with him it seems that his doctor did not provide any alternatives. I
work in the functional foods area and have been working on heart health for the past 2 years and
know there are many clinical trials. Would he be eligible to be put on a transplant list?

Possibly.

Quoted message said:

How can I best help him?

Convince him to get a second opinion from an independent cardiologist.

Quoted message said:

I appreciate your help.

You are welcome :-)

Humbly,

Andrew

--
Dr. Andrew B. Chung, MD/PhD
Board-Certified Cardiologist
heartmdphd.comheartmdphd.comOpen ↗

5 Jan 2004 06:18:36 -0800 in article
<[email hidden]> [email hidden]

(lacie001) said:

I would appreciate any help or insight the physicians on this board could provide.

My father, a 60 year old male, was diagnosed with congestive heart failure 7 years ago. He went in
for an angioplasty with stent placement and ended up in an emergency quadruple bypass. At the time,
given the circumstances, he was given a 50/50 chance of living. He is a fighter and came back from
the bypass and returned to work in only 3 weeks.

Last night we were talking and he asked me to keep a secret for him. He told me that his doctor
told him 3 weeks ago that he had 6 to 18 months to live due to the CHF. He has been on a protocol
of diuretics, cholesterol reducers and heart medications for the last 7 years. He was told he has
approximately 30% of his heart muscle left. Obviously this really shook me up and I've been
searching for answers. He says he feels great, in fact better than he had prior to the bypass.

I know I have not provided all the information necessary, but is there anything that can be done?
Based on my conversation with him it seems that his doctor did not provide any alternatives. I work
in the functional foods area and have been working on heart health for the past 2 years and know
there are many clinical trials. Would he be eligible to be put on a transplant list? How can I best
help him?

This is probably a very long shot, but has his vitamin D status been checked? See my other message
about a study that concluded that low vitamin D status may be a contributing factor in the
pathogenesis of congestive heart failure. The best indicator of vitamin D status is a test that
measures the amount of 25-hydroxy vitamin D in blood serum, see

25-hydroxy vitamin D <URL:http://www.pennhealth.com/ency/article/003569.htm>

Medical Tests - 25-hydroxy vitamin D <URL:http://www.uhseast.com/13893.cfm>

--
Matti Narkia

Tue, 06 Jan 2004 03:10:25 +0200 in article
<[email hidden]> Matti Narkia

Quoted message said:

5 Jan 2004 06:18:36 -0800 in article <[email hidden]>

(lacie001) said:

I would appreciate any help or insight the physicians on this board could provide.

My father, a 60 year old male, was diagnosed with congestive heart failure 7 years ago. He went in
for an angioplasty with stent placement and ended up in an emergency quadruple bypass. At the
time, given the circumstances, he was given a 50/50 chance of living. He is a fighter and came
back from the bypass and returned to work in only 3 weeks.

Last night we were talking and he asked me to keep a secret for him. He told me that his doctor
told him 3 weeks ago that he had 6 to 18 months to live due to the CHF. He has been on a protocol
of diuretics, cholesterol reducers and heart medications for the last 7 years. He was told he has
approximately 30% of his heart muscle left. Obviously this really shook me up and I've been
searching for answers. He says he feels great, in fact better than he had prior to the bypass.

I know I have not provided all the information necessary, but is there anything that can be done?
Based on my conversation with him it seems that his doctor did not provide any alternatives. I
work in the functional foods area and have been working on heart health for the past 2 years and
know there are many clinical trials. Would he be eligible to be put on a transplant list? How can
I best help him?

This is probably a very long shot, but has his vitamin D status been checked? See my other message
about a study that concluded that low vitamin D status may be a contributing factor in the
pathogenesis of congestive heart failure. The best indicator of vitamin D status is a test that
measures the amount of 25-hydroxy vitamin D in blood serum, see

25-hydroxy vitamin D <URL:http://www.pennhealth.com/ency/article/003569.htm>

Medical Tests - 25-hydroxy vitamin D <URL:http://www.uhseast.com/13893.cfm>

I'm not a doctor, so it's better to check everything I write with the treating physician. My
viewpoint is the potential benefit of some nutritional supplements. Evidence is scarce, but in a
difficult situation perhaps even a weaker evidence could be considered.

Several studies have reported elevated markers of free radical mediated injury in patients with
congestive heart failure (CHF), and the link between oxidative stress and the genesis and
progression of chronic CHF is being increasingly explored. Some individual antioxidant supplements
have been tested in clinical trials, but results have been conflicting. Selenium may be one of the
most promising antioxidants. Better strategy may be to use a combination of several antioxidants,
such as vitamin E (including gamma-tocopherol and possibly also tocotrienols), selenium, vitamin C
and perhaps some herbal antioxidants. Coenzyme Q10 has also been tested, but again results have been
conflicting. It may still be worth a try (under doctor's supervision of course) in a difficult
situation. One of the most promising supplements seems to be propionyl-L-carnitine (perhaps also L-
carnitine or/and acetyl-L-carnitine). Systemic inflammation has also been associated with congestive
heart failure, therefore anti-inflammatory supplements such as fish oil could be worth trying. It
probably wouldn't hurt to take also some other heart-friendly supplements such as magnesium, folic
acid and other B-vitamins. But naturally all this has to be discussed with the treating physician.

Some references:

1: Manar MJ, MacPherson GD, Mcardle F, Jackson MJ, Hart CA. Selenium status, kwashiorkor and
congestive heart failure. Acta Paediatr. 2001 Aug;90(8):950-2. PMID: 11529549 [PubMed - indexed
for MEDLINE] <URL:http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uid-
s=11529549&dopt=Abstract>

2: Seelig MS. Interrelationship of magnesium and congestive heart failure. Wien Med Wochenschr. 2000;150(15-16):335-
41. Review. PMID: 11105329 [PubMed - indexed for MEDLINE] <URL:http://www.ncbi.nlm.nih.gov/entr-
ez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=11529549&dopt=Abstract>

3: Gorelik O, Almoznino-Sarafian D, Feder I, Wachsman O, Alon I, Litvinjuk V, Roshovsky M, Modai D,
Cohen N. Dietary intake of various nutrients in older patients with congestive heart failure.
Cardiology. 2003;99(4):177-81. PMID: 12845243 [PubMed - indexed for MEDLINE] <URL:http://www.nc-
bi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=12845243&dopt=Abstract>

4: Keith M, Geranmayegan A, Sole MJ, Kurian R, Robinson A, Omran AS, Jeejeebhoy KN. Increased
oxidative stress in patients with congestive heart failure. J Am Coll Cardiol. 1998 May;31(6):1352-
6. PMID: 9581732 [PubMed - indexed for MEDLINE] <URL:http://www.ncbi.nlm.nih.gov/entrez/query.f-
cgi?cmd=Retrieve&db=PubMed&list_uids=9581732&dopt=Abstract>

5: Anand I, Chandrashekhan Y, De Giuli F, Pasini E, Mazzoletti A, Confortini R, Ferrari R. Acute
and chronic effects of propionyl-L-carnitine on the hemodynamics, exercise capacity, and
hormones in patients with congestive heart failure. Cardiovasc Drugs Ther. 1998 Jul;12(3):291-9.
PMID: 9784909 [PubMed - indexed for MEDLINE] <URL:http://www.ncbi.nlm.nih.gov/entrez/query.fcgi-
?cmd=Retrieve&db=PubMed&list_uids=9784909&dopt=Abstract>

6: Mancini M, Rengo F, Lingetti M, Sorrentino GP, Nolfe G. Controlled study on the therapeutic
efficacy of propionyl-L-carnitine in patients with congestive heart failure.
Arzneimittelforschung. 1992 Sep;42(9):1101-4. PMID: 1445476 [PubMed - indexed for MEDLINE] <U-
RL:http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=1445476&dop-
t=Abstract>

7: Sriram K, Peterson JK, O'Gara J, Hammond JM. Clinical improvement of congestive heart failure
after selenium supplementation in total parenteral nutrition. Acta Pharmacol Toxicol (Copenh).
1986;59 Suppl 7:361-4. No abstract available. PMID: 3096074 [PubMed - indexed for MEDLINE] <U-
RL:http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=3096074&dop-
t=Abstract>

8: Moskowitz R, Kukin M. Oxidative stress and congestive heart failure. Congest Heart Fail. 1999
Jul-Aug;5(4):153-163. PMID: 12189307 [PubMed - as supplied by publisher] <URL:http://www.ncbi.n-
lm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=12189307&dopt=Abstract>

9: Singal PK, Khaper N, Farahmand F, Bello-Klein A. Oxidative stress in congestive heart failure.
Curr Cardiol Rep. 2000 May;2(3):206-11. Review. PMID: 10980894 [PubMed - indexed for MEDLINE]
<URL:http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=10980894&do-
pt=Abstract>

10. Aukrust P, Damas JK, Gullestad L. Immunomodulating therapy: new treatment modality in congestive
heart failure. Congest Heart Fail. 2003 Mar-Apr;9(2):64-9. Review. PMID: 12671336 [PubMed -
indexed for MEDLINE] <URL:http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&-
list_uids=12671336&dopt=Abstract>

"Accumulating evidence indicates that inflammatory cytokines play a pathogenic role in
congestive heart failure (CHF) by influencing heart contractility, inducing hypertrophy, and
promoting apoptosis or fibrosis, contributing to the continuous myocardial remodeling
process. ..."

Olexa P, Olexova M, Gonsorcik J, Tkac I, Kisel'ova J, Olejnikova M. ks Uric acid--a marker for
systemic inflammatory response in patients with congestive heart failure? Wien Klin Wochenschr. 2002
Mar 28;114(5-6):211-5. PMID: 12238311 [PubMed - indexed for MEDLINE] <URL:http://www.ncbi.nlm.nih.g-
ov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=12238311&dopt=Abstract>

Blum A, Miller H. Pathophysiological role of cytokines in congestive heart failure. Annu Rev Med.
2001;52:15-27. Review. PMID: 11160765 [PubMed - indexed for MEDLINE] <URL:http://www.ncbi.nlm.nih.g-
ov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=11160765&dopt=Abstract>

--
Matti Narkia

Google found, among others, the following Congestive Heart Failure web
sites:

Congestive Heart Failure <URL:http://www.americanheart.org/presenter.jhtml?identifier=1486>

Congestive Heart Failure and Pulmonary Edema <URL:http://www.emedicine.com/EMERG/topic108.htm>

Congestive Heart Failure - Texas Heart Institute Heart Information Center
<URL:http://www.tmc.edu/thi/chf.html>

Congestive Heart Failure in the United States: A New Epidemic National Heart, Lung, and Blood
Institute National Institutes of Health Data Fact Sheet
<URL:http://www.nhlbi.nih.gov/health/public/heart/other/CHF.htm>

Congestive Heart Failure (CHF) - CardiologyChannel <URL:http://www.cardiologychannel.com/chf/>

HeartPoint: Congestive Heart Failure <URL:http://www.heartpoint.com/congheartfailure.html>

Congestive Heart Failure The latest medical news and information for patients or friends/parents of
patients diagnosed with Congestive Heart Failure. <URL:http://www.docguide.com/news/content.nsf/Pat-
ientResAllCateg/Congestive%20Heart%20Failure?OpenDocument>

MEDLINEplus: Heart Failure <URL:http://www.nlm.nih.gov/medlineplus/heartfailure.html>

Cohn JN. Preventing congestive heart failure. Am Fam Physician. 1998 Apr 15;57(8):1901-4. Review.
<URL:http://www.aafp.org/afp/980415ap/cohn.html>

--
Matti Narkia

Tue, 06 Jan 2004 04:07:29 +0200 in article
<[email hidden]> Matti Narkia <[email hidden]>

Quoted message said:

Several studies have reported elevated markers of free radical mediated injury in patients with
congestive heart failure (CHF), and the link between oxidative stress and the genesis and
progression of chronic CHF is being increasingly explored. Some individual antioxidant supplements
have been tested in clinical trials, but results have been conflicting. Selenium may be one of the
most promising antioxidants. Better strategy may be to use a combination of several antioxidants,
such as vitamin E (including gamma-tocopherol and possibly also tocotrienols), selenium, vitamin C
and perhaps some herbal antioxidants. Coenzyme Q10 has also been tested, but again results have
been conflicting. It may still be worth a try (under doctor's supervision of course) in a difficult
situation. One of the most promising supplements seems to be propionyl-L-carnitine (perhaps also
L-carnitine or/and acetyl-L-carnitine). Systemic inflammation has also been associated with
congestive heart failure, therefore anti-inflammatory supplements such as fish oil could be worth
trying. It probably wouldn't hurt to take also some other heart-friendly supplements such as
magnesium, folic acid and other B-vitamins. But naturally all this has to be discussed with the
treating physician.

Interesting link:

Congestive Heart Failure <URL:http://www.doctoryourself.com/congestive.html>

Taurine may also be worth considering:

Azuma J. Long-term effect of taurine in congestive heart failure: preliminary report. Heart Failure
Research with Taurine Group. Adv Exp Med Biol. 1994;359:425-33. No abstract available. <URL:http://-
www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=7887286&dopt=Abstract>

Azuma J, Sawamura A, Awata N. Usefulness of taurine in chronic congestive heart failure and its
prospective application. Jpn Circ J. 1992 Jan;56(1):95-9. <URL:http://www.ncbi.nlm.nih.gov/entrez/q-
uery.fcgi?cmd=Retrieve&db=PubMed&list_uids=1538580&dopt=Abstract>

Orlova TsR, Elizarova EP, Ryff IM, Fetisova NI, Mit'kina LI. [Use of taurine in the treatment of
experimental congestive heart failure] Kardiologiia. 1991 Jun;31(6):77-80. Russian. <URL:http://www-
.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=1921137&dopt=Abstract>

Popovich MI, Kobets VA, Kapel'ko VI. [Norepinephrine-induced heart failure and the protective effect
of taurine] Fiziol Zh. 1990 Nov-Dec;36(6):8-12. Russian <URL:http://www.ncbi.nlm.nih.gov/entrez/que-
ry.fcgi?cmd=Retrieve&db=PubMed&list_uids=2083593&dopt=Abstract>

Takihara K, Azuma J, Awata N, Ohta H, Hamaguchi T, Sawamura A, Tanaka Y, Kishimoto S, Sperelakis N.
Beneficial effect of taurine in rabbits with chronic congestive heart failure. Am Heart J. 1986 Dec;112(6):1278-
84. <URL:http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=3788775&dop-
t=Abstract>

Azuma J, Sawamura A, Awata N, Ohta H, Hamaguchi T, Harada H, Takihara K, Hasegawa H, Yamagami T,
Ishiyama T, et al. Therapeutic effect of taurine in congestive heart failure: a double-blind
crossover trial. Clin Cardiol. 1985 May;8(5):276-82. <URL:http://www.ncbi.nlm.nih.gov/entrez/query.-
fcgi?cmd=Retrieve&db=PubMed&list_uids=3888464&dopt=Abstract>

Azuma J, Hasegawa H, Sawamura A, Awata N, Ogura K, Harada H, Yamamura Y, Kishimoto S. Therapy of
congestive heart failure with orally administered taurine. Clin Ther. 1983;5(4):398-408. <URL:http:-
//www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=6871923&dopt=Abstract>

--
Matti Narkia