Heart Disease and Heart Attack – The Cardiac Cycle

Posted On February 2, 2019

Excerpts from previous naturopathy assignments HLT60512. Description of the cardiac cycle and the different phases

The CC is measured in each heartbeat. Two sounds can be heard when listening with a stethoscope. Lub: the sound of atrioventricular valves closing, and dub: the semi lunar valves closing. CC viewed on an electrocardiogram shows waves P, Q, R, S, T.  The P wave is the activation of the two upper chambers (atria), QRST lower chambers (ventricles), T is the recovery phase. The

7 phases of the cardiac cycle also describe the physiology of the heart as it goes through P, Q, R, S, T  (Klabunde, PhD, 2018), (Harvard Health Publishing , 2011) see appendix. 2

Other texts will state that there are 5 distinct phases to each cardiac cycle from the generation of one heartbeat to the generation of the next

The Cardiac Cycle General Information

A normal range of beats for the heart is 60-100 beats per minute (BPM) with a normal pulse (+2) and blood pressure less than 120/80 systole/diastole (elevated 120-140/80-90mmHg), (low below 90/60 mmHg), (high 140-190/90-100mmHg). This gives a practitioner an indication of cardiac (and kidney) health and vascular resistance.

At the first phase (1) ‘atrial contraction’ of CC Atrioventricular Valves (AV) are open and Semilunar valves (SV) are closed. Atria and ventricles are in diastole (filling). In the ‘Isovolumetric phase’ (2) all valves are closed. The pressure gradient has caused the atria to contract (systole) and forcibly pump blood past the open (AV) into the ventricles which then contract (systole) to prevent blood flowing back into the atria the AV close and make the first sound ‘lub’. In phase (3) ‘Rapid ejection’ ventricle pressure rises above two major arteries and pushes open 2 (SV) valves into the pulmonary trunk and aorta. Phase (4) ‘Reduced ejection’ The ventricles repolarise from the ejection stages and begin to relax (diastole), the AV valves remain closed to prevent blood flow back to atria. The second heart sound, S2 or dub, occurs when the semilunar valves close. In phase (5) ‘Isovolumetric relaxation’ the

(SV) valves close and the second heart sound, ‘dub’ can be heard in phases (6) and (7) Rapid and reduce filling of the atria occurs (respectively) when pressure falls and blood from the atria moves again into the ventricles the (AV) valves are again open (in diastole) and this is the completion of 1 cardiac cycle (Klabunde, PhD, 2018).

Excerpt from previous naturopathy assignment HLT60512. Case Study Sample of Client Heart Failure Diagnosis.

‘A heart failure has significant implications for health and longevity. Define congestive heart failure and explain how it impacts on overall health of the cardiovascular system’

Congestive heart failure can be systolic (SHF) or diastolic heart failure (DHF) and can occur together or in isolation.  SHF results in abnormal ‘stroke volume, contractility, preload and afterload’ (Craft, et al., 2011, p. 666) and will inadequately nourish vital tissues. Diastolic heart failure occurring alone with preserved systolic function results in pulmonary congestion from lesser function of the left ventricle and: ‘abnormal diastolic relaxation resulting in increased left ventricular end diastolic pressure’ (Craft, et al., 2011, pp. 666-672).  CHF where SHF and DHF occur together results in more serious outcomes because systemic and pulmonary circulation are both affected.

Some causes of CHF can be:

‘coronary artery disease, high blood pressure, heart valve disease, endocarditis or myocarditis, arrhythmias, heart attack, diabetes, obesity, high cholesterol, kidney conditions, thyroid disease, or anaemia’ ( Vanderbilt University , 2013)

Long term medical management and lifestyle changes will increase life expectancy with CHF.

Excerpts from previous naturopathy assignments: ‘Compare and contrast the normal physiology of the lymphatic system to the fluid balance changes observed in congestive heart failure’

The function of the lymphatic system is to collect all the fluid with small plasma proteins (not blood cells) that are forced out from the capillaries by blood pressure (Nieuwenhuizen, n.d.).  Lymph gathers this fluid to bring it back into circulation (via one way lymphatic valves to the heart) preventing fluid accumulation in the tissues. The second purpose is immunity e.g. If there is bacteria present in the fluid it is taken to the nearest lymph node (Waldeyers ring of lymph nodes) where B and T cells act as antigens. The third purpose is protein, and lipid diffusion to the blood e.g. in the digestive system where glucose absorbs through the cells lining the intestines diffusing into the capillaries, fatty acids which are packaged into chylomicrons in the cells, and are too big to diffuse into capillaries, therefore going through the lymphatic system first. Furthermore diffusion is achieved in another way e.g. hormones, proteins, or wastes from the tissues in the body first diffuse into lymph from where they’re carried into circulation via the heart (it’s not viable for them to diffuse immediately via capillaries) to reach organs of the body for further metabolism for example, liver or kidneys (Nieuwenhuizen, n.d.)

In contrast to normal lymphatic functioning, abnormal functioning due to CHF results in blood and lymph not moving efficiently around the body. The implications are further problems with normal homeostatic body functioning thus resulting in a buildup of metabolites and potential toxic overload. Actions required are medical intervention, medications, and lifestyle changes which restore adequate functioning and prolong life.

Adherence to medical advice is crucial to the clients health and well being.

Recommend 3 lifestyle changes for George’s case and explain the implications for George if he does not make these changes.

Regular physical activity and stress reduction along with eating a balanced diet within daily kilojoule limits and weight loss is recommended. Whilst too much exercise may exacerbate a heart condition – working towards mild low intensity exercise like walking 30 minutes a day 5-7 times per week will help reduce stress (Canadian Journal of Cardiology, 2016)

Dietary sodium below 2g per day is a generally accepted recommendation (Craft, et al., 2011, p. 673).

Reduction of fluid intake to 1.5 litres/day including beverages and in severe cases with hyponatraemia reduce intake to 1 litre/day. ‘National Heart Foundation Australia and New Zealand’ (Craft, et al., 2011, p. 673).

If the client doesn’t successfully make overall lifestyle changes progression of heart failure will occur leading to death.

 Briefly outline the benefit lymphatic drainage massage would have for this case.

Lymphatic drainage massage would have a holistic benefit, lowering stress, promoting relaxation, and assisting circulation and gentle detoxification of metabolic wastes.

A graph depicts a number of biological markers that are used to determine if someone has had a heart attack. In a normal blood test, troponin, CK and LDH would all be zero. Using these biological markers, the doctors were able to tell the client that his heart attack had occurred the week prior to the visit to the hospital.

4. Using the graph (not in this post) explain how the doctors would be able to determine their timeframe.

Day 1: Troponin, Lactic acid dehydrogenase (LDH), and creatinine kinase (CK) all rise above normal levels and continue rising and continue to reach their peak well above normal levels in the same day before declining and levelling out into above normal levels but not as high on days 2-4 indicating heart muscle damage has occurred.

Day 4-10: levels stabilise above normal with LDH slower to decline than troponin by day16. CK stops at day 10 though has returned to normal levels in days 3-10. LDH and Troponin are still above normal levels and only gradually declining over 2 weeks through todays14 to 16 where they return to within normal range but still above 0.

Day 10-16: Everything is within normal range between days 14 to 16. CK stops in the graph at 10

1. In another set of blood tests (this time in a fasted state), it was found that Serum triglycerides are 2.7mmol/L and his serum LDL is 4.29mmol/L. Explain the significance of  levels in comparison with the normal reference range of these blood markers.  Test Normal Range

Triglycerides 0.6 – 2.0mmol/L

LDL 0.0 – 4.0mmol/L

Triglyceride levels are above the normal range and are 2.7 mmol/L 0.7 above the highest normal range limit of 2.0mmmol/L. His Serum LDL is 4.39mmol/L which is 0.39mmol/L above the highest normal range limit of 4.0mmol/L. This signifies that the medical course of action for bringing this back to ‘normal range’ is likely to be medication and accompanied lifestyle changes.

Name two (2) common drugs that are used to treat high cholesterol levels.

Statins lower high cholesterol, two are; Atorvastatin (brand names include Lipitor, Lorstat) and Fluvastatin (Lescol or Vastin).

Along with Statin medication other well researched recommendations are Nicotinic acid, fish oil, and plant sterols as good fats actively lower the bad fats within limits).

(My Dr, n.d.)

For each mediation discuss two (2) of the possible adverse side effects.

Side effects for both Atorvastatin and fluvastatin are: mild stomach upset, headache, and less often muscle pain and hepatitis which requires monitoring (My Dr, n.d.)

Outline an action plan to address identified health needs: Please record your treatment modality at the beginning of the answers.

Naturopathic Treatment

• Naturopathic diagnosis recommendations are;

‘Investigate blood pressure, 25(OH) D –Serum Vitamin D. Essential fatty acids, functional liver detoxification profile, cardiovascular disability scales’ (Hechtman, 2012, p. 1009)

• Follow cardiovascular disability scales: using the New York Heart Association (NYHA) Functional Classification (Hechtman, 2012, p. 1009).

George may be in class 3 of scales 1-4 ‘comfortable at rest. ‘Less than ordinary activity causes fatigue, palpitation, dyspnoea, angina pain’ (Hechtman, 2012, p.

1008).

Work with therapists and specialists as part of treatment plan. Dietary and lifestyle changes will assist treatment. A nutritionally balanced diet including vitamins, minerals, and herbs where deficiencies occur will assist the body to heal. Nutrients outlined in Clinical Naturopathic Medicine (Hechtman, 2012, p.1010) are below:

‘B complex, magnesium, essential fatty acids, vitamin E, Co-enzyme Q 10, and vitamin C…Herbal recommendations are Hawthorn, Withania, Astragalus, Motherwort, and olive Leaf’ (Hechtman, 2012, pp. 1008-1015).

Specific vitamins, minerals and herbs are transcribed in Table 3 below. Dosages are given as outlined in (Hechtman, 2012, pp. 1014-15)

Possible prescriptions (refer to individual case history first). ‘Vitamins, Minerals, and Herbs Dosages’ Hechtman (2012) Dosage

Requirements (Pp 1014-15) Leah Hechtman. Clinical Naturopathic Medicine, Elsevier. NSW

Name	Dosage Requirement
Thiamine	20-40mg/day
Riboflavin	20-40mg/day
Niacinamide / nicotinic acid	50-100mg/day
Pantothenic acid	150-300mg/day
Pyridoxine	20-60mg/day
Folic acid	500-1000mg/day
Cyanocobalamin	500-1000mg/day
Choline	50-100mg/day
Inositol	50-100mg/day
Biotin	250-500mg/day
Additional support: Niacinamide/nicotinic acid	Extra B3 100mg+ for high cholesterol
Pyridoxine	Extra B6 75-100mg+ for high homocysteine levels
Folic Acid	Extra B9 500microgram-5mg for high homocysteine levels
Cyanocobalamin	Extra B12 500-1000microgram for high homocysteine levels
Magnesium	500-1000mg/day
EFA’s	5.1g/day
Vit E	400 I.U b.d.
Co-enzyme Q 10	350-900mg/day
Vit C	2g/day divided doses
Herb Name	Dosage Requirement
Hawthorn	1:2  Daily 7.5 ml
Withania	1:2 Daily 13.5 ml
Astragalus	1:2 Daily 9.0 ml
Motherwort	1:2 Daily 3.8 ml
Olive leaf	1:2 Daily 7.5ml
Total Tincture Above Information: (Hechtman, 2012) (Pp 1014-15) Elsevier. NSW	41.3 ml Daily in divided doses 13.8ml  3x daily

 

Staying within your mode of training, briefly outline your plan of action for

George. Include the following: Health conditions (contra-indications) you are addressing

Congestive Heart Failure

Signs: Stage 3 NYHA, Obesity, High Blood Pressure, High Cholesterol, Oedema, Renal dysfunction, Insulin Resistance, Stress, Dyspnoea, Hyponatremia, Ischemia and Family history of heart failure.

Plan of action

• Discuss with George supportive framework for ongoing health care and how this can work with work commitment and obligations. There may be room George to negotiate a different role within his workplace and or to take some time off to stabilise his health before returning to work
• Implement Vitamin, mineral, and herbal supplementation
• Implement mild exercise 5 x weekly
• Begin other medical tests for George e.g. regular blood pressure checks, 25(OH) D Serum Vitamin D. Essential fatty acids, digestion and functional liver detoxification profile (Hechtman, 2012, p. 1009).
• Support Specialists and Allied health professionals

Lifestyle change recommendations (within your modality)

• Exercise
• Dietary
• Nutritional and herbal supplementation
• Medication
• Relaxation
• Meditation

What treatments you will offer (within your modality)

• Massage
• Reiki
• Nutrition advice / menu planning
• Nutritional supplementation prescriptions
• herbal prescriptions
• Iridology
• Health care checks; BP, Blood glucose, Weight checks and measurements
• Flower essences
• Basic personal counselling

When and how you will follow up with George

By appointment and weekly or fortnightly. Follow up call to communicate and discuss progress

How you will monitor the impact of your services for George in line with your job role.

Health Markers – stabilised body function including weight loss and improved health and lifestyle satisfaction due to Medications and Naturopathic treatment interventions.

Part 3: Implement services to address health needs

• Identify the allied health professionals you would refer George to for each medical condition.

The following Allied health practitioners are all able to help George in rehabilitation and ongoing health care: ‘Dietitians, exercise physiologists, occupational therapists.’ ( Heart Foundation, 2010)

• Briefly outline the strategies you will use to assess the success of your treatment

Documentation, communication, discussion, improved health, weight and blood pressure and physical markers

Briefly outline what you will do if you were not successful in facilitating treatment goals.

Refer to other medical professionals and allied health practitioners:

‘General physicians, general practitioners (GP), nurses (including nurses with cardiology training, community nurses, palliative care specialist nurses and practice nurses), pharmacists (including hospital pharmacists, community pharmacists and accredited pharmacists), physiotherapists, psychologists and social workers.’ ( Heart Foundation, 2010)

Explain why it is so important to keep detailed client records.

It’s mandatory to keep detailed client records and have information to refer back to at each appointment for current assessment and future planning goals.

Analyse the legal obligation to obtain consent from the client and explain how your plan for services complies with this requirement. 

Obtaining patient consent is a mandatory legal obligation for patient health (Department of Health and Human Services, n.d.) (Australian Government. Australian Law Reform Commision, n.d.) A client intake form will obtain necessary information for treatment and explain to the client the type of health service being provided. It asks for the clients consent to receive medical advice and treatment. The patient has a right to seek a second opinion and or services elsewhere however the consent form is a contract that outlines that the practitioner is not responsible for health implications caused from the client not adhering to the practitioners recommended treatment. (Department of Health and Human Services, n.d.)

Heather Indiana Rose

Copyright 2019