I am presenting a case report of a 40 year old male who had recently been diagnosed with heart failure (HF) about one year prior to our initial visit. The patient, P.D. (whose initials have been changed for confidentiality) presented in March 2019 with shortness of breath (SOB) even during rest; dyspnea on exertion (DOE); orthopnea; light-headedness; foggy-mind; physical and mental exhaustion that worsened with even the slightest physical exertion; intermittent palpitations; racing heart; bloating and flatulence. Current diagnoses included Type 1 diabetes mellitus, hypertension, insomnia, anxiety, and PTSD (from mental, physical and sexual abuse, abandonment by parents as well as from growing up in a foreign country during a time of civil unrest). He had a past medical history of a concussion, several motor vehicle accidents, and migraines. At the time of his initial appointment, he was on a medical leave of absence from work as his symptoms were affecting his activities of daily living (ADLs).
Due to his diagnoses, P.D. was on a host of pharmaceutical medications including: insulin and canagliflozin for his diabetes; a statin prescribed for primary prevention of hypercholesterolemia; candesartan, carvedilol, spironolactone, and amlodipine for his HF; and lastly trazodone for sleep. He rated his stress at 9/10 (10 = worst) primarily because of his perceived hopelessness for the future, his current state of health and fear of not being able to be a good father to his daughter.
At the initial visit, I reviewed his medication-related side effects and his medication-induced nutrient depletions in detail. The patient reported his current medication protocol was currently “at 40% of what it should be” which made him scared of the life he would have in future, given his medication-related side effects and dosing regimen were currently unmanageable. We agreed that optimizing his medication protocol, reducing those less beneficial, would be most favorable.
At his next visit, we initiated a protocol of L-carnitine, CoQ10, and magnesium bisglycinate for nutrient repletion and optimal cardiac function. Given the challenge in prescribing herbal supplements with P.D.’s lengthy medication list, I opted to prescribe adjunctive homeopathic medicines for their safety profile as I knew that interactions would not be an issue. Homeopathic medicines are prescribed according to a patient’s individualized symptom picture. For P.D., I prescribed the homeopathic medicines Arnica montana for his physical traumas and muscular fatigue. I also prescribed Kali-carbonicum for his symptoms of DOE, nocturnal dyspnea, dyspnea improved by sitting in a flexed forward position, muscular and cardiac fatigue with the slightest exertion, HF, anxiety, fear, general asthenia, depressive symptoms, and, flatulent dyspepsia.
At our third follow-up visit (two weeks later), P.D. stated he had been compliant with his supps and had weaned off his statin and the trazodone. As a result, he noticed an improvement in his post-exertional fatigue and reported, “I can get around the house a bit easier”. He also experienced reduced foggy-mind, muscle pain and fatigue. Furthermore, his SOB was occurring less frequently at rest, and his bloating and flatulence had reduced by 50%. Nothing new was prescribed at this time.
On his fourth follow-up (two weeks later), he noted further improvements. His dyspnea reduced in intensity making it easier for him to complete his ADLs, and he reported that his body “felt stronger”. Since he had completed the Arnica and Kali-carbonicum, I changed his homeopathic prescription to Apocynum cannabinum, indicated for heart failure, arrhythmia, marked asthenia and muscular weakness. I also prescribed Grindelia indicated for cardiac and respiratory failure with the symptoms of dyspnea when lying supine, and a sensation of suffocation.
At his fifth follow-up (two weeks later), P.D. reported that since his initial appointment, his SOB at rest had decreased by 20%, his DOE had decreased by 60%, his energy had improved by 10%, and his stress had decreased by 65% and was currently “5/10 at the most” (10 = worst). Although his overall symptoms had improved, he continued to experience sleep onset insomnia, for which I prescribed the homeopathic Coffea cruda. He had since had a Technetium pyrophosphate scintography and a follow-up appointment with his cardiologist. According to P.D., his cardiologist stated that he “wasn’t responding as expected” to the beta-blocker so suggested that since his heart was “looking good”, P.D. could wean slowly off the carvedilol.
Ten days later at his sixth follow-up visit, P.D. reported that his palpitations and brain fog had resolved and noted an improvement in fatigue with each passing week. He denied any current sleep onset insomnia since starting the Coffea cruda, and he also denied orthopnea lending to sleep maintenance insomnia, as it had been previous. He reported that his DOE had improved so much that he was able to play badminton with his daughter at a “moderate activity level” without dyspnea or discomfort, and that he had gone out dancing for his birthday without difficulty.
Several double-blinded studies have shown carnitine to be of benefit for ventricular ejection fraction and maximal exercise time in patients with CHF. Similarly, CoQ10 was found to improve a host of CHF-related symptoms, some of which include increased contraction, ejection fraction, and stroke volume, as well as an improvement in the staging of CHF. Magnesium is of particular importance in CHF as levels have been shown to directly correlate with survival, reducing arrhythmias, activating ATPases, protecting against hypokalemia, and decreasing inflammatory markers. I’ve found that homeopathic medicines can be of immense benefit, particularly in cases of polypharmacy, where other herbal or nutrient-based treatments are limited because of medication interactions. I always find that the synergy of treatment combinations can lend to enhanced benefits overall.
Over three months of treatment, not only did P.D.’s symptoms significantly improve, the comparisons of his 2018 and 2019 MRIs also showed significant improvements in his cardiac function. His left ventricular ejection fraction increased from 42% in 2018 to 59% in 2019, putting him back into the normal range (55-70%). Although the elimination of side effects from the reduction in PD’s overall medications may have contributed to his improvement, the benefits from taking evidence-informed supplements and homeopathics have definitely also contributed to the improvement in his overall health.
