Cause: chiefly high intake of fat meat, milk and dairy products. Atherosclerosis is the hardening process that takes place where calcium is deposited in the arteries. See: HYPERLIPIDAEMIA.
Atherosclerosis can be the forerunner of degenerative heart and kidney disease, with rise in blood pressure.
A study of Australian ’flu epidemic diseases revealed influenza as a major cause of cardiovascular disease and in particular, atherosclerosis.
Causes. Excessive smoking and alcohol, fatty foods, hereditary weakness, stress and emotional tension that release excessive adrenalin into the bloodstream. Toxic effects of environmental poisons (diesel fumes). Fevers.
Symptoms. Cold hands and feet, headache, giddiness. Diminished mental ability due to thickening of arteries in the brain. Pain on exertion, breathlessness and fatigue. Diagnosis of atheroma of main arteries: by placing stethoscope over second right intercostal space, half inch from the sternum, the second aortic sound will be pronounced.
Treatment. Surface vasodilators, Cardioactives. Anti-cholesterols.
Alternatives. Teas. To lower cholesterol levels and shrink hardened plaque: Alfalfa, Chamomile, Borage, Olive leaves, Mint, Nettles, Marigold, Garlic, Lime flowers, Yarrow, Horsetail, Hawthorn, Ginkgo, Orange Tree leaves, Meadowsweet, Eucalyptus leaves, Ispaghula, Bromelain. Rutin (Buckwheat tea).
Artichoke leaves. Spanish traditional. 2 teaspoons to each cup of water; simmer 2 minutes. Drink cold: 1 cup 2-3 times daily.
Mistletoe leaves. 1-2 teaspoons to each cup cold water steeped 8 hours (overnight). Half-1 cup thrice daily.
Tablets, or capsules. Garlic, Mistletoe, Poke root, Rutin, Hawthorn, Motherwort, Ginkgo, Bamboo gum. Liquid Extracts. Mix Hawthorn 2; Mistletoe 1; Barberry 1; Rutin 1; Poke root half. Dose: 30-60 drops thrice daily.
Tinctures. Mix: Hawthorn 2; Cactus flowers 2; Mistletoe 1; Capsicum half. Dose: 1-2 teaspoons thrice daily in water before meals.
Powders. Mix equal parts: Bamboo gum, Hawthorn, Mistletoe, Rutin, Ginger. Fill 00 capsules. Dose: 2-4 capsules, or quarter to half a teaspoon (375-750mg) thrice daily before meals.
Threatened stroke. Tincture Arnica BPC (1949): 3-5 drops in water morning and evening. Practitioner only.
Evening Primrose oil. Favourable results reported. (Maxepa)
Diet. Vegetarian. Low fat. Low salt. High fibre. Lecithin, polyunsaturated oils, artichokes, oily fish (see entry). Linseed on breakfast cereal. Garlic at meals, or Garlic tablets or capsules at night to reduce cholesterol.
Vitamins. A, B-complex, B6, B12, C (2g), E (400iu), daily.
Minerals. Chromium, Iodine, Potassium, Selenium, Magnesium, Manganese, Zinc.
“A man is as old as his arteries” – Thomas Sydenham, 17th century physician.
“A man’s arteries are as old as he makes them” – Robert Bell MD, 19th century physician. ... atherosclerosis
– sometimes acute anxiety – brings it on and pain may be severe and felt also in the arms and the jaw. The condition, which is aggravated by cold weather, is the result of the heart’s demand for blood being greater than that which the coronary arteries can provide. This failure is most often due to narrowing of the coronary arteries by ATHEROMA; rarely, it may be caused by congenital defects in the arteries rendering them incapable of carrying su?cient blood to meet increased demands from the body.
Angina may be relieved or prevented by such drugs as glyceryl trinitrate and propranolol. If
drug treatment does not work, surgery on the coronary arteries such as angioplasty or bypass grafts may be necessary. People who suffer from angina pectoris need advice on their lifestyle, and in particular on diet, exercise and avoidance of smoking or excessive alcohol consumption. They may have high blood pressure, which will also require medical treatment (see HEART, DISEASES OF; HYPERTENSION).... angina pectoris
A high blood-cholesterol level – that is, one over 6 mmol per litre or 238 mg per 100 ml – is undesirable as there appears to be a correlation between a high blood cholesterol and ATHEROMA, the form of arterial degenerative disease associated with coronary thrombosis and high blood pressure. This is well exempli?ed in DIABETES MELLITUS and HYPOTHYROIDISM, two diseases in which there is a high blood cholesterol, sometimes going as high as 20 mmol per litre; patients with these diseases are known to be particularly prone to arterial disease. There is also a familial disease known as hypercholesterolaemia, in which members of affected families have a blood cholesterol of around 18 mmol per litre or more, and are particularly liable to premature degenerative disease of the arteries. Many experts believe that there is no ‘safe level’ and that everybody should attempt to keep their cholesterol level as low as possible.
Cholesterol exists in three forms in the blood: high-density lipoproteins (HDLs) which are believed to protect against arterial disease, and a low-density version (LDLs) and very low-density type (VLDLs), these latter two being risk factors.
The rising incidence of arterial disease in western countries in recent years has drawn attention to this relationship between high levels of cholesterol in the blood and arterial disease. The available evidence indicates that there is a relationship between blood-cholesterol levels and the amount of fat consumed; however, the blood-cholesterol level bears little relationship to the amount of cholesterol consumed, most of the cholesterol in the body being produced by the body itself.
On the other hand, diets high in saturated fatty acids – chie?y animal fats such as red meat, butter and dripping – tend to raise the blood-cholesterol level; while foods high in unsaturated fatty acids – chie?y vegetable products such as olive and sun?ower oils, and oily ?sh such as mackerel and herring – tend to lower it. There is a tendency in western society to eat too much animal fat, and current health recommendations are for everyone to decrease saturated-fat intake, increase unsaturated-fat intake, increase daily exercise, and avoid obesity. This advice is particulary important for people with high blood-cholesterol levels, with diabetes mellitus, or with a history of coronary thrombosis (see HEART, DISEASES OF). As well as a low-cholesterol diet, people with high cholesterol values or arterial disease may be given cholesterol-reducing drugs such as STATINS, but this treatment requires full clinical assessment and ongoing medical monitoring. Recent research involving the world’s largest trial into the effects of treatment to lower concentrations of cholesterol in the blood showed that routine use of drugs such as statins reduced the incidence of heart attacks and strokes by one-third, even in people with normal levels of cholesterol. The research also showed that statins bene?ted women and the over-70s.... cholesterol
Causes These include injury – especially that sustained in war – disease, FROSTBITE, severe burns, ATHEROMA in large blood vessels, and diseases such as DIABETES MELLITUS and RAYNAUD’S DISEASE. Gas gangrene is a form that occurs when injuries are infected with soil contaminated with gas-producing bacilli such as Clostridium welchii, which are found in well-cultivated ground.
Treatment Dry gangrene must be kept dry, and AMPUTATION of the dead tissue performed when a clear demarcation line with healthy tissue has formed. Wet gangrene requires urgent surgery and prompt use of appropriate antibiotics.... gangrene
Aneurysms generally arise in the elderly, with men affected more commonly than women. The most common cause is degenerative atheromatous disease, but other rarer causes include trauma, inherited conditions such as MARFAN’S SYNDROME, or acquired conditions such as SYPHILIS or POLYARTERITIS NODOSA. Once formed, the pressure of the circulating blood within the aneurysm causes it to increase in size. At ?rst, there may be no symptoms or signs, but as the aneurysm enlarges it becomes detectable as a swelling which pulsates with each heartbeat. It may also cause pain due to pressure on local nerves or bones. Rupture of the aneurysm may occur at any time, but is much more likely when the aneurysm is large. Rupture is usually a surgical emergency, because the bleeding is arterial and therefore considerable amounts of blood may be lost very rapidly, leading to collapse, shock and even death. Rupture of an aneurysm in the circle of Willis causes subarachnoid haemorrhage, a life-threatening event. Rupture of an aneurysm in the abdominal aorta is also life-threatening.
Treatment Treatment is usually surgical. Once an aneurysm has formed, the tendency is for it to enlarge progressively regardless of any medical therapy. The surgery is often demanding and is therefore usually undertaken only when the aneurysm is large and the risk of rupture is therefore increased. The patient’s general ?tness for surgery is also an important consideration. The surgery usually involves either bypassing or replacing the affected part of the artery using a conduit made either of vein or of a man-made ?bre which has been woven or knitted into a tube. Routine X-ray scanning of the abdominal aorta is a valuable preventive procedure, enabling ‘cold’ surgery to be performed on identi?ed aneurysms.... aneurysm
Its branches, in order, are: two coronary arteries to the heart wall; the brachiocephalic, left common carotid, and left subclavian arteries to the head, neck and upper limbs; several small branches to the oesophagus, bronchi, and other organs of the chest; nine pairs of intercostal arteries which run around the body between the ribs; one pair of subcostal arteries which is in series with the intercostal arteries; four (or ?ve) lumbar arteries to the muscles of the loins; coeliac trunk to the stomach, liver and pancreas; two mesenteric arteries to the bowels; and suprarenal, renal and testicular arteries to the suprarenal body, kidney, and testicle on each side. From the termination of the aorta rises a small branch, the median sacral artery, which runs down into the pelvis. In the female the ovarian arteries replace the testicular.
The chief diseases of the aorta are ATHEROMA
and ANEURYSM. (See ARTERIES, DISEASES OF; COARCTATION OF THE AORTA.)... aorta
Arrhythmias An abnormal rate or rhythm of the heartbeat. The reason is a disturbance in the electrical impulses within the heart. Sometimes a person may have an occasional irregular heartbeat: this is called an ECTOPIC beat (or an extrasystole) and does not necessarily mean that an abnormality exists. There are two main types of arrhythmia: bradycardias, where the rate is slow – fewer than 60 beats a minute and sometimes so slow and unpredictable (heartblock) as to cause blackouts or heart failure; and tachycardia, where the rate is fast – more than 100 beats a minute. A common cause of arrhythmia is coronary artery disease, when vessels carrying blood to the heart are narrowed by fatty deposits (ATHEROMA), thus reducing the blood supply and damaging the heart tissue. This condition often causes myocardial infarction after which arrhythmias are quite common and may need correcting by DEFIBRILLATION (application of a short electric shock to the heart). Some tachycardias result from a defect in the electrical conduction system of the heart that is commonly congenital. Various drugs can be used to treat arrhythmias (see ANTIARRHYTHMIC DRUGS). If attacks constantly recur, the arrhythmia may be corrected by electrical removal of dead or diseased tissue that is the cause of the disorder. Heartblock is most e?ectively treated with an arti?cial CARDIAC PACEMAKER, a battery-activated control unit implanted in the chest.
Cardiomyopathy Any disease of the heart muscle that results in weakening of its contractions. The consequence is a fall in the e?ciency of the circulation of blood through the lungs and remainder of the body structures. The myopathy may be due to infection, disordered metabolism, nutritional excess or de?ciency, toxic agents, autoimmune processes, degeneration, or inheritance. Often, however, the cause is not identi?ed. Cardiomyopathies are less common than other types of heart diseases, and the incidence of di?erent types of myopathy (see below) is not known because patients or doctors are sometimes unaware of the presence of the condition.
The three recognised groups of cardiomyopathies are hypertrophic, dilated and restrictive.
•Hypertrophic myopathy, a familial condition, is characterised by great enlargement of the muscle of the heart ventricles. This reduces the muscle’s e?ciency, the ventricles fail to relax properly and do not ?ll suf?ciently during DIASTOLE.
In the dilated type of cardiomyopathy, both ventricles overdilate, impairing the e?ciency of contraction and causing congestion of the lungs.
In the restrictive variety, proper ?lling of the ventricles does not occur because the muscle walls are less elastic than normal. The result is raised pressure in the two atria (upper cavities) of the heart: these dilate and develop FIBRILLATION. Diagnosis can be di?cult and treatment is symptomatic, with a poor prognosis. In suitable patients, heart TRANSPLANTATION may be considered. Disorders of the heart muscle may also be
caused by poisoning – for example, heavy consumption of alcohol. Symptoms include tiredness, palpitations (quicker and sometimes irregular heartbeat), chest pain, di?culty in breathing, and swelling of the legs and hands due to accumulation of ?uid (OEDEMA). The heart is enlarged (as shown on chest X-ray) and ECHOCARDIOGRAPHY shows thickening of the heart muscle. A BIOPSY of heart muscle will show abnormalities in the cells of the heart muscle.
Where the cause of cardiomyopathy is unknown, as is the case with most patients, treatment is symptomatic using DIURETICS to control heart failure and drugs such as DIGOXIN to return the heart rhythm to normal. Patients should stop drinking alcohol. If, as often happens, the patient’s condition slowly deteriorates, heart transplantation should be considered.
Congenital heart disease accounts for 1–2 per cent of all cases of organic heart disease. It may be genetically determined and so inherited; present at birth for no obvious reason; or, in rare cases, related to RUBELLA in the mother. The most common forms are holes in the heart (atrial septal defect, ventricular septal defect – see SEPTAL DEFECT), a patent DUCTUS ARTERIOSUS, and COARCTATION OF THE AORTA. Many complex forms also exist and can be diagnosed in the womb by fetal echocardiography which can lead to elective termination of pregnancy. Surgery to correct many of these abnormalities is feasible, even for the most severe abnormalities, but may only be palliative giving rise to major diffculties of management as the children become older. Heart transplantation is now increasingly employed for the uncorrectable lesions.
Coronary artery disease Also known as ischaemic heart disease, this is a common cause of symptoms and death in the adult population. It may present for the ?rst time as sudden death, but more usually causes ANGINA PECTORIS, myocardial infarction (heart attack) or heart failure. It can also lead to a disturbance of heart rhythm. Factors associated with an increased risk of developing coronary artery disease include diabetes, cigarette smoking, high blood pressure, obesity, and a raised concentration of cholesterol in the blood. Older males are most affected.
Coronary thrombosis or acute myocardial infarction is the acute, dramatic manifestation of coronary-artery ischaemic heart disease – one of the major killing diseases of western civilisation. In 1999, ischaemic heart disease was responsible for about 115,000 deaths in England and Wales, compared with 153,000 deaths in 1988. In 1999 more than 55,600 people died of coronary thrombosis. The underlying cause is disease of the coronary arteries which carry the blood supply to the heart muscle (or myocardium). This results in narrowing of the arteries until ?nally they are unable to transport su?cient blood for the myocardium to function e?ciently. One of three things may happen. If the narrowing of the coronary arteries occurs gradually, then the individual concerned will develop either angina pectoris or signs of a failing heart: irregular rhythm, breathlessness, CYANOSIS and oedema.
If the narrowing occurs suddenly or leads to complete blockage (occlusion) of a major branch of one of the coronary arteries, then the victim collapses with acute pain and distress. This is the condition commonly referred to as a coronary thrombosis because it is usually due to the affected artery suddenly becoming completely blocked by THROMBOSIS. More correctly, it should be described as coronary occlusion, because the ?nal occluding factor need not necessarily be thrombosis.
Causes The precise cause is not known, but a wide range of factors play a part in inducing coronary artery disease. Heredity is an important factor. The condition is more common in men than in women; it is also more common in those in sedentary occupations than in those who lead a more physically active life, and more likely to occur in those with high blood pressure than in those with normal blood pressure (see HYPERTENSION). Obesity is a contributory factor. The disease is more common among smokers than non-smokers; it is also often associated with a high level of CHOLESTEROL in the blood, which in turn has been linked with an excessive consumption of animal, as opposed to vegetable, fats. In this connection the important factors seem to be the saturated fatty acids (low-density and very low-density lipoproteins [LDLs and VLDLs] – see CHOLESTEROL) of animal fats which would appear to be more likely to lead to a high level of cholesterol in the blood than the unsaturated fatty acids of vegetable fats. As more research on the subject is carried out, the arguments continue about the relative in?uence of the di?erent factors. (For advice on prevention of the disease, see APPENDIX 2: ADDRESSES: SOURCES OF INFORMATION, ADVICE, SUPPORT AND SELFHELP.)
Symptoms The presenting symptom is the sudden onset, often at rest, of acute, agonising pain in the front of the chest. This rapidly radiates all over the front of the chest and often down over the abdomen. The pain is frequently accompanied by nausea and vomiting, so that suspicion may be aroused of some acute abdominal condition such as biliary colic (see GALLBLADDER, DISEASES OF) or a perforated PEPTIC ULCER. The victim soon goes into SHOCK, with a pale, cold, sweating skin, rapid pulse and dif?culty in breathing. There is usually some rise in temperature.
Treatment is immediate relief of the pain by injections of diamorphine. Thrombolytic drugs should be given as soon as possible (‘rapid door to needle time’) and ARRHYTHMIA corrected. OXYGEN is essential and oral ASPIRIN is valuable. Treatment within the ?rst hour makes a great di?erence to recovery. Subsequent treatment includes the continued administration of drugs to relieve the pain; the administration of ANTIARRHYTHMIC DRUGS that may be necessary to deal with the heart failure that commonly develops, and the irregular action of the heart that quite often develops; and the continued administration of oxygen. Patients are usually admitted to coronary care units, where they receive constant supervision. Such units maintain an emergency, skilled, round-the-clock sta? of doctors and nurses, as well as all the necessary resuscitation facilities that may be required.
The outcome varies considerably. The ?rst (golden) hour is when the patient is at greatest risk of death: if he or she is treated, then there is a 50 per cent reduction in mortality compared with waiting until hospital admission. As each day passes the prognosis improves with a ?rst coronary thrombosis, provided that the patient does not have a high blood pressure and is not overweight. Following recovery, there should be a gradual return to work, care being taken to avoid any increase in weight, unnecessary stress and strain, and to observe moderation in all things. Smoking must stop. In uncomplicated cases patients get up and about as soon as possible, most being in hospital for a week to ten days and back at work in three months or sooner.
Valvular heart disease primarily affects the mitral and aortic valves which can become narrowed (stenosis) or leaking (incompetence). Pulmonary valve problems are usually congenital (stenosis) and the tricuspid valve is sometimes involved when rheumatic heart disease primarily affects the mitral or aortic valves. RHEUMATIC FEVER, usually in childhood, remains a common cause of chronic valvular heart disease causing stenosis, incompetence or both of the aortic and mitral valves, but each valve has other separate causes for malfunction.
Aortic valve disease is more common with increasing age. When the valve is narrowed, the heart hypertrophies and may later fail. Symptoms of angina or breathlessness are common and dizziness or blackouts (syncope) also occur. Replacing the valve is a very e?ective treatment, even with advancing age. Aortic stenosis may be caused by degeneration (senile calci?c), by the inheritance of two valvular leaflets instead of the usual three (bicuspid valve), or by rheumatic fever. Aortic incompetence again leads to hypertrophy, but dilatation is more common as blood leaks back into the ventricle. Breathlessness is the more common complaint. The causes are the same as stenosis but also include in?ammatory conditions such as SYPHILIS or ANKYLOSING SPONDYLITIS and other disorders of connective tissue. The valve may also leak if the aorta dilates, stretching the valve ring as with HYPERTENSION, aortic ANEURYSM and MARFAN’S SYNDROME – an inherited disorder of connective tissue that causes heart defects. Infection (endocarditis) can worsen acutely or chronically destroy the valve and sometimes lead to abnormal outgrowths on the valve (vegetations) which may break free and cause devastating damage such as a stroke or blocked circulation to the bowel or leg.
Mitral valve disease leading to stenosis is rheumatic in origin. Mitral incompetence may be rheumatic but in the absence of stenosis can be due to ISCHAEMIA, INFARCTION, in?ammation, infection and a congenital weakness (prolapse). The valve may also leak if stretched by a dilating ventricle (functional incompetence). Infection (endocarditis) may affect the valve in a similar way to aortic disease. Mitral symptoms are predominantly breathlessness which may lead to wheezing or waking at night breathless and needing to sit up or stand for relief. They are made worse when the heart rhythm changes (atrial ?brillation) which is frequent as the disease becomes more severe. This leads to a loss of e?ciency of up to 25 per cent and a predisposition to clot formation as blood stagnates rather than leaves the heart e?ciently. Mitral incompetence may remain mild and be of no trouble for many years, but infection must be guarded against (endocarditis prophylaxis).
Endocarditis is an infection of the heart which may acutely destroy a valve or may lead to chronic destruction. Bacteria settle usually on a mild lesion. Antibiotics taken at vulnerable times can prevent this (antibiotic prophylaxis) – for example, before tooth extraction. If established, lengthy intravenous antibiotic therapy is needed and surgery is often necessary. The mortality is 30 per cent but may be higher if the infection settles on a replaced valve (prosthetic endocarditis). Complications include heart failure, shock, embolisation (generation of small clots in the blood), and cerebral (mental) confusion.
PERICARDITIS is an in?ammation of the sac covering the outside of the heart. The sac becomes roughened and pain occurs as the heart and sac rub together. This is heard by stethoscope as a scratching noise (pericardial rub). Fever is often present and a virus the main cause. It may also occur with rheumatic fever, kidney failure, TUBERCULOSIS or from an adjacent lung problem such as PNEUMONIA or cancer. The in?ammation may cause ?uid to accumulate between the sac and the heart (e?usion) which may compress the heart causing a fall in blood pressure, a weak pulse and circulatory failure (tamponade). This can be relieved by aspirating the ?uid. The treatment is then directed at the underlying cause.... heart, diseases of
Every cardiac prescription for this condition should include a gentle diuretic to assist kidney function. The kidneys should be borne in mind, the most appropriate diuretic being Dandelion which would also make good any potassium loss. ... heart – fibrous degeneration
Treatment There is evidence that therapy which lowers the lipid concentration reduces the progression of premature atheroma, particularly in those who suffer from the familial disorder. Treatment should include appropriate diets, usually food that is low in cholesterol and saturated fats. There are a number of drugs available for lowering the lipid content of the plasma, but these should be reserved for patients in whom severe hyperlipidaemia is inadequately controlled by weight reduction. Anion-exchange resins – clo?brate, beza?brate and gem?brozil, for example – and statins such as atorvastatin and simvastatin, as well as nicotinic acid, all lower plasma cholesterol and plasma triglyceride concentration through their e?ect on reducing the hepatic production of lipoproteins. Cholestyramine and colestipol, both of which are anion-exchange resins, bind bile salts in the gut and so decrease the absorption of the cholesterol that these bile salts contain – hence lowering plasma cholesterol concentrations. Probucol lowers plasma cholesterol concentrations by increasing the metabolism of low-density lipoproteins.
The statins (atorvastatin, cerivastatin, ?uvastatin, pravastatin and simvastatin) inhibit an enzyme involved in synthesising cholesterol, especially in the liver. They are more e?ective than anion-exchange resins in lowering LDL (low-density lipoprotein) cholesterol – a form of low-density cholesterol carried in the bloodstream, high levels of which are believed to be the main cause of atheroma. Statins are, however, less e?ective than the clo?brate group in reducing triglycerides and raising HDL (highdensity lipoprotein) cholesterol (high-density cholesterol).... hyperlipidaemia
Habitat: Cultivated in gardens throughout India; also found wild in Peninsular India.
English: Ceylon Leadwort, Leadwort.Ayurvedic: Chitraka, Agni, Vahni, Jvalanaakhya, Krshaanu, Hutaasha, Dahana, Sikhi.Unani: Sheetraj Hindi. Siddha/Tamil: Chittramoolam.Action: Root—intestinal flora normalizer, stimulates digestive processes; used for dyspepsia. Root paste is applied in order to open abscesses; a paste prepared with milk, vinegar or salt and water, is used externally in leprosy and other obstinate skin diseases. A cold infusion is used for influenza and black-water fever.
Key application: In sprue, malabsorption syndrome, piles and inflammatory diseases of ano-rectum. (The Ayurvedic Pharmacopoeia of India.)The root yielded naphthoquinone derivatives, plumbagin being the most important active principle.The root extract, after processing for plumbagin enhancement, has been used in a number of drug formulations for liver ailments. Experimentally, plumbagin prevented the accumulation of triglycerides in liver and aorta and regressed atheromatous plaques and abdominal aorta. The chloroform extract of the root showed significant activity against pencillin-resistant (also non-pencillin resistant) strains of Neisseria gonorrhoea. (The root is used for treating sexually transmitted diseases in traditional Indian medicine.)In Siddha medicine, in Tamil Nadu, the plant is an ingredient in a number of drug formulations for treating cancers of the uterus, breast, lungs and oral cavity, in addition to haemorrhoids.Plumbagin is abortifacient, antiovu- latory; causes selective testicular lesions in dogs; in lower doses it behaves like a spindle poison, in higher concentration exhibits radiomimetic nu- cleotoxic and cytotoxic effects.Dosage: Detoxified root—1-2 g powder. (API, Vol. I.)... plumbago zeylanicaBlood pressure is measured using two values. The systolic pressure – the greater of the two – represents the pressure when blood is pumped from the left VENTRICLE of the heart into the AORTA. The diastolic pressure is the measurement when both ventricles relax between beats. The pressures are measured in millimetres (mm) of mercury (Hg). Despite the grey area between normal and raised blood pressure, the World Health Organisation (WHO) has de?ned hypertension as a blood pressure consistently greater than 160 mm Hg (systolic) and 95 mm Hg (diastolic). Young children have readings well below these, but blood pressure rises with age and a healthy person may well live symptom free with a systolic pressure above the WHO ?gure. A useful working de?nition of hypertension is the ?gure at which the bene?ts of treating the condition outweigh the risks and costs of the treatment.
Between 10 and 20 per cent of the adult population in the UK has hypertension, with more men than women affected. Incidence is highest in the middle-aged and elderly. Because most people with hypertension are symptomless, the condition is often ?rst identi?ed during a routine medical examination, otherwise a diagnosis is usually made when complications occur. Many people’s blood pressure rises when they are anxious or after exercise, so if someone’s pressure is above normal at the ?rst testing, it should be taken again after, say, 10 minutes’ rest, by which time the reading should have settled to the person’s regular level. BP measurements should then be taken on two subsequent occasions. If the pressure is still high, the cause needs to be determined: this is done using a combination of personal and family histories (hypertension can run in families), a physical examination and investigations, including an ECG and blood tests for renal disease.
Over 90 per cent of hypertensive people have no immediately identi?able cause for their condition. They are described as having essential hypertension. In those patients with an identi?able cause, the hypertension is described as secondary. Among the causes of secondary hypertension are:
Lifestyle factors such as smoking, alcohol, stress, excessive dietary salt and obesity.
Diseases of the KIDNEYS.
Pregnancy (ECLAMPSIA).
Various ENDOCRINE disorders – for example, PHAEOCHROMOCYTOMA, CUSHING’S DISEASE, ACROMEGALY, thyrotoxicosis (see under THYROID GLAND, DISEASES OF).
COARCTATION OF THE AORTA.
Drugs – for example, oestrogen-containing oral contraceptives (see under CONTRACEPTION), ANABOLIC STEROIDS, CORTICOSTEROIDS, NON-STEROIDAL ANTIINFLAMMATORY DRUGS (NSAIDS).
Treatment People with severe hypertension may need prompt admission to hospital for urgent investigation and treatment. Those with a mild to moderate rise in blood pressure for which no cause is identi?able should be advised to change their lifestyle: smokers should stop the habit, and those with high alcohol consumption should greatly reduce or stop their drinking. Obese people should reduce their food consumption, especially of animal fats, and take more exercise. Everyone with hypertension should follow a low-salt diet and take regular exercise. Patients should also be taught how to relax, which helps to reduce blood pressure and, if they have a stressful life, working patterns should be modi?ed if possible. If these lifestyle changes do not reduce a person’s blood pressure su?ciently, drugs to achieve this will be needed. A wide range of anti-hypertensive drugs are available on prescription.
A ?rst-line treatment is one of the THIAZIDES, e?ective at a low dosage and especially useful in the elderly. Beta blockers (see BETAADRENOCEPTOR-BLOCKING DRUGS), such as oxprenolol, acebutol or atenolol, are also ?rst-line treatments. ACE inhibitors (see ANGIOTENSIN-CONVERTING ENZYME (ACE) INHIBITORS) and CALCIUM-CHANNEL BLOCKERS can be used if the ?rst-line choices are not e?ective. The drug treatment of hypertension is complex, and sometimes various drugs or combinations of drugs have to be tried to ?nd what regimen is e?ective and suits the patient. Mild to moderate hypertension can usually be treated in general practice, but patients who do not respond or have complications will normally require specialist advice. Patients on anti-hypertensive treatments require regular monitoring, and, as treatment may be necessary for several years, particular attention should be paid to identifying sideeffects. Nevertheless, e?ective treatment of hypertension does enable affected individuals to live longer and more comfortable lives than would otherwise be the case. Older people with moderately raised blood pressure are often able to live with the condition, and treatment with anti-hypertensive drugs may produce symptoms of HYPOTENSION.
In summary, hypertension is a complex disorder, with di?erent patients responding di?erently to treatment. So the condition sometimes requires careful assessment before the most e?ective therapy for a particular individual is identi?ed, and continued monitoring of patients with the disorder is advisable.
Complications Untreated hypertension may eventually result in serious complications. People with high blood pressure have blood vessels with thickened, less ?exible walls, a narrowed LUMEN and convoluted shape. Sometimes arteries become rigid. ANEURYSM may develop and widespread ATHEROMA (fat deposits) is apparent in the arterial linings. Such changes adversely affect the blood supply to body tissues and organs and so damage their functioning. Patients suffer STROKE (haemorrhage from or thrombosis in the arteries of the BRAIN) and heart attacks (coronary thrombosis
– see HEART, DISEASES OF). Those with hypertension may suffer damage to the retina of the EYE and to the OPTIC DISC. Indeed, the diagnosis of hypertension is sometimes made during a routine eye test, when the doctor or optician notices changes in the retinal arteries or optic disc. Kidney function is often affected, with patients excreting protein and excessive salt in their urine. Occasionally someone with persistent hypertension may suffer an acceleration of damage to the blood vessels – a condition described as ‘malignant’ hypertension, and one requiring urgent hospital treatment.
Hypertension is a potentially dangerous disease because it develops into a cycle of self-perpetuating damage. Faulty blood vessels lead to high blood pressure which in turn aggravates the damage in the vessels and thus in the tissues and organs they supply with blood; this further raises the affected individual’s blood pressure and the pathological cycle continues.... hypertension
Thrombosis may occur in the vessels of the brain and thus causes STROKE in people whose arteries are much diseased.
Thrombosis of a coronary artery of the heart is a very serious condition which affects, as a rule, middle-aged or elderly people.
(See also ARTERIES, DISEASES OF; COAGULATION; HEART, DISEASES OF – Coronary thrombosis; VEINS, DISEASES OF.)... thrombosis
When fatty deposits occur in various parts of the body – skin, brain, cornea, internal organs and tendons – the condition is called xanthomatosis. Treatment is of the underlying conditions, an important aim being to lower the concentrations of fats in the body.
Xanthomata have a variety of manifestations which may point to the underlying cause. These include:
Eruptive Eruptive yellow papules on the buttocks.
Plane Yellow plaques or macules in the skin.
Tuberous Nodules on the elbows or knees.
Tendinous Subcutaneous nodules ?xed to tendons, particularly those on the back of the ?ngers and the ACHILLES TENDON.... xanthoma
Condition also caused by a spasm in the coronary circulation. ‘Strangling pain in the chest’, lasting 2 to 10 minutes. Aggravated by diabetes, anaemia, goitre, high blood pressure and stress.
Is it angina? Important evidence is the association of the pain with exercise and its relief by rest. Pain is similar to intermittent claudication (pain in the calf muscle). Sense of constriction in front of chest: may radiate to the jaw or left arm.
Atherosclerosis (hardening of the arteries) is caused by cholesterol deposits hindering blood flow. It is the work of the practitioner to unclog blocked arteries where possible.
Phytotherapy may increase exercise capacity, reduce the number of angina attacks, and is known to enjoy a low incidence of unwanted side-effects.
Alternatives. Teas. Chamomile, Hawthorn, Motherwort, Lime Flowers, Hops, Oats (avena), Orange Tree leaves.
Tablets/capsules. Cayenne, Hawthorn, Lobelia, Prickly Ash.
Powders. Formula. Equal parts: Hawthorn berries, Opuntia (Cactus flowers), Mistletoe, Motherwort. Dose: 750mg (three 00 capsules or half a teaspoon) thrice daily.
Liquid extracts: Formula: Equal parts: Cactus, Hawthorn, Prickly Ash. Dose: 1-2 teaspoons. Thrice daily.
Tinctures: Formula. Hawthorn BHP (1983) 30ml; Motherwort BHP (1983) 30ml; Prickly Ash bark BHP (1983) 20ml; Tincture Capsicum Fort BPC 1934: 0.25ml. Dose: 5ml in water thrice daily.
Practitioner. Alternatives:–
1. Tincture Aconite, BPC 1949 : 2-5 drops (0.12 to 0.3ml) when necessary.
2. Liquid extract: Lobelia BHP (1983): 10-30 drops every 20 minutes when necessary.
3. Formula. Tincture Selenicereus grand (preferably fresh plant) 1oz; Tincture Ginger quarter of an ounce. Dose: 15-30 drops every 15 minutes.
4. Formula. Liquid extract: Prickly Ash bark 20ml; Liquid extract: Cactus 20ml. Mix. Dose: 5-20 drops when necessary. (A. Barker, FNIMH)
5. Emergency. Tincture Gelsemium BPC 1973. Dose: 5 drops (0.3ml).
Diet: See: DIET – HEART AND CIRCULATION. Vitamin E reduces the risk of angina. ... angina
Alternatives. Teas. Lime flowers, Nettles, Horsetail, Ginkgo, Oats, Mistletoe, Yarrow.
Tea. Mix equal parts: Ginkgo, Hawthorn, Yarrow. One heaped teaspoon to each cup boiling water; infuse 5-10 minutes; 1 cup thrice daily.
Tablets/capsules. Ginkgo, Hawthorn, Prickly Ash.
Diet. See: DIET–HEART AND CIRCULATION.
Supplements. Daily: Vitamin E 1000mg; B6 50mg; B12 2mcg. Selenium 200mcg; Zinc 15mg. Strict bedrest; regulate bowels; avoid excessive physical and mental exertion. ... cerebral thrombosis
Symptoms. High cholesterol levels, pathological laughing and crying, depression, delusion. Alternatives. Evening Primrose, Oats, Alfalfa, Garlic. German Chamomile, Gotu Kola, Ginkgo, Ginseng. Hawthorn, Rutin.
Powders. Formula: Hawthorn 3; Ginkgo 2; Lily of the Valley 1. Dose: 500mg (two 00 capsules or one- third teaspoon) thrice daily.
Liquid Extracts. Formula as for powders. Dose: one 5ml teaspoon thrice daily.
Tinctures. Formula as above. Dose: two 5ml teaspoons thrice daily.
Guar gum. Lowers serum fat levels, body weight and blood pressure.
Aromatherapy: massage and inhalation: Rosemary.
Arnica. Lotion: 1 part Tincture Arnica to 20 parts distilled extract Witch Hazel. Wipe over forehead and hair-line 1-3 times daily.
Diet. Egg-yolk, Lecithin, Oatmeal porridge.
Supplements. Vitamins A, B-complex, B12, C and E. Choline, Folic acid, Magnesium, Manganese, Zinc. ... dementia, (atherosclerotic)
A radical is a group of atoms which can combine in the same way as single atoms to make a molecule. Free means uncombined. A free radical is a state in which a radical can exist before it combines – an incomplete molecule containing oxygen which has an uneven electrical charge. High energy oxygen atoms are known to form atheroma.
As well as being substances that take part in a process of metabolism, free radicals can be found in industrial fumes and cigarette smoke. They are oxidants and have an anti-bacterial effect. But their activity is not confined to bacteria alone. When produced in large amounts as in inflammation and infection, they may have a damaging effect upon the lining of blood vessels and other tissues. An excess is produced in ischaemic heart disease. They have been shown to be involved in jet lag, Alzheimer’s disease, rheumatoid arthritis, thrombosis, heart failure, cancer, irradiation sickness and a weak immune system. Damaging to the DNA, they are probably the greatest single cause of ill health. They hasten the ageing process. Vitamins A, C, E, being antioxidants and the mineral Selenium stimulate certain enzyme systems to limit damage done by these destructive elements.
Losing weight is believed to generate free radicals – a metabolic side-effect of dieting. See: ANTIOXIDANTS. ... free radicals
Coronary thrombosis is more common in the West because of its preference for animal fats; whereas in the East fats usually take the form of vegetable oils – corn, sunflower seed, sesame, etc. Fatty deposits (atheroma) form in the wall of the coronary artery, obstructing blood-flow. Vessels narrowed by atheroma and by contact with calcium and other salts become hard and brittle (arterio-sclerosis) and are easily blocked. Robbed of oxygen and nutrients heart muscle dies and is replaced by inelastic fibrous (scar) tissue which robs the heart of its maximum performance.
Severe pain and collapse follow a blockage. Where only a small branch of the coronary arterial tree is affected recovery is possible. Cause of the pain is lack of oxygen (Vitamin E). Incidence is highest among women over 40 who smoke excessively and who take The Pill.
The first warning sign is breathlessness and anginal pain behind the breastbone which radiates to arms and neck. Sensation as if the chest is held in a vice. First-line agent to improve flow of blood – Cactus.
For cholesterol control target the liver. Coffee is a minor risk factor.
Measuring hair calcium levels is said to predict those at risk of coronary heart disease. Low hair concentrations may be linked with poor calcium metabolism, high aortic calcium build-up and the formation of plagues. (Dr Allan MacPherson, nutritionist, Scottish Agricultural College, Ayr, Scotland)
Evidence has been advanced that a diagonal ear lobe crease may be a predictor for coronary heart disease. (American Journal of Cardiology, Dec. 1992)
Tooth decay is linked to an increased risk of coronary heart disease and mortality, particularly in young men. (Dr Frank De Stefano, Marshfield Medical Research Foundation, Wisconsin, USA) Treatment. Urgency. Send for doctor or suitably qualified practitioner. Absolute bedrest for 3 weeks followed by 3 months convalescence. Thereafter: adapt lifestyle to slower tempo and avoid undue exertion. Stop smoking. Adequate exercise. Watch weight.
Cardiotonics: Motherwort, Hawthorn, Mistletoe, Rosemary. Ephedra, Lily of the Valley, Broom.
Cardiac vasodilators relax tension on the vessels by increasing capacity of the arteries to carry more blood. Others contain complex glycosides that stimulate or relax the heart at its work. Garlic is strongly recommended as a preventative of CHD.
Hawthorn, vasodilator and anti-hypertensive, is reputed to dissolve deposits in thickened and sclerotic arteries BHP (1983). It is believed to regulate the balance of lipids (body fats) one of which is cholesterol.
Serenity tea. Equal parts: Motherwort, Lemon Balm, Hawthorn leaves or flowers. 1 heaped teaspoon to each cup boiling water; infuse 5-15 minutes; 1 cup freely.
Decoction. Combine equal parts: Broom, Lily of the Valley, Hawthorn. 1-2 teaspoons to each cup water gently simmered 20 minutes. Half-1 cup freely.
Tablets/capsules. Hawthorn, Motherwort, Cactus, Mistletoe, Garlic.
Practitioner. Formula. Hawthorn 20ml; Lily of the Valley 10ml; Pulsatilla 5ml; Stone root 5ml; Barberry 5ml. Tincture Capsicum 1ml. Dose: Powders: 500mg (two 00 capsules or one-third teaspoon). Liquid extracts: 1 teaspoon. Tinctures: 2 teaspoons. Thrice daily in water or honey.
Prevention: Vitamin E – 400iu daily.
Diet. See: DIET – HEART AND CIRCULATION.
Supplements. Daily. Vitamin C, 2g. Vitamin E possesses anti-clotting properties, 400iu. Broad spectrum multivitamin and mineral including chromium, magnesium selenium, zinc, copper.
Acute condition. Strict bed-rest; regulate bowels; avoid excessive physical and mental exertion. Meditation and relaxation techniques dramatically reduce coronary risk. ... coronary heart disease
Constituents. Flavonoids, phenolic acids, tannins, amines.
Action. Positive heart restorative. Coronary vasodilator BHP (1983), antispasmodic, antihypertensive, adaptogen, diuretic, sedative to nervous system, cholesterol and mineral solvent. Action lacks the toxic effects of digitalis. Useful where digitalis is not tolerated.
Uses: To increase blood flow through the heart. Strengthens heart muscle without increasing the beat or raising blood pressure. Enhances exercise duration. Myocarditis with failing compensation. Improves circulation in coronary arteries. Arteriosclerosis, atheroma, thrombosis, rapid heart beat, paroxysmal tachycardia BHP (1983), fatty degeneration; angina, enlargement of the heart from over-work, over- exercise or mental tension, alcoholic heart, Buerger’s disease, intermittent claudication, risk of infarction, dizziness (long term), mild to moderate hypertension, insomnia. Used by sportsmen to sustain the heart under maximum effort.
Preparations: Thrice daily.
Tea. Leaves and flowers. 1-2 teaspoons to each cup boiling water; infuse 5-10 minutes. Dose: 1 cup. Traditional for insomnia or for the heart under stress.
Decoction. Fruits. 1-2 heaped teaspoons haws to each cup water; simmer gently 2 minutes. Dose: half-1 cup.
Tablets/capsules. Two 200-250mg.
Liquid extract. 8-15 drops in water.
Tincture. 1:5 in 45 per cent alcohol, dose: 15-30 drops (1-2ml).
Popular combinations:–
With Mistletoe and Valerian (equal parts) as a sedative for nervous heart.
With Lily of the Valley 1; Hawthorn berries 2; for cardiac oedema.
With Lime flowers, Mistletoe and Valerian (equal parts) for high blood pressure.
With Horseradish or Cayenne, as a safe circulatory stimulant.
Gradual onset of action. Low incidence of side-effects. No absolute contra-indications.
Note: Dr D. Greene, Ennis, County Clare, Eire, attained an international reputation for treatment of heart disease keeping the remedy a secret. Upon his death his daughter revealed it as a tincture of red-ripe Hawthorn berries. Pharmacy only ... hawthorn
While cure is not possible, atheroma may be arrested by a cup of herbal tea: Hawthorn blossoms, Motherwort, Horsetail: single or in combination. 1-2 teaspoons to each cup boiling water; infuse 5-15 minutes; 1-2 cups daily.
Formula. Hawthorn 2; Ginkgo 2; Horsetail 1; Ginger quarter. Dose. Powders: 500mg (two 00 capsules or one-third teaspoon). Liquid extracts: 1 teaspoon. Tinctures: 2 teaspoons. Twice daily: morning and evening in water or honey.
Diet. See: DIET – HEART AND CIRCULATION. Few grains of Cayenne pepper as seasoning on food once daily.
Stop smoking. ... heart – degeneration, in the elderly
Constituents: flavonoids, alkaloids, sterols, silicic acid.
Action: haemostatic for bleeding of genitourinary organs, styptic, a soothing non-irritating diuretic. Increases coagulability of the blood. Remineraliser. Anti-atheroma. Antirheumatic. Astringent. Immune enhancer. White blood cell stimulator.
Uses: Blood in the urine, prostatitis, bed-wetting, dropsy, chronic bladder infections, incontinence in the aged, catarrh of the urinary organs, gravel, urethritis of sexual transmission with bleeding, stricture, severe pain in the bladder unrelieved by passing water, constant desire to pass water without relief. Carcinoma of the womb: cure reported. Foetid discharges of STD. Arteriosclerosis.
Silica, as in Horsetail, preserves elasticity of connective tissue; controls absorption of calcium and is a necessary ingredient of nails, hair, teeth and the skeleton. Its cleansing properties rapidly remove urates, uric acid and cellulites from the system. Hastens repair of tissue after lung damage of tuberculosis or other diseases.
Combinations. (1) With Shepherd’s Purse for blood in the urine. (2) With Pulsatilla to inhibit growth of uterine fibroid. (3) With Buchu for cystitis. (4) With Oats and Goldenseal for renal exhaustion. “Combines well with Hydrangea for non-malignant prostatitis.” (F. Fletcher Hyde) Arteriosclerosis. (Dr Max Rombi)
Preparations: Horsetail has a heavy mineral content (silica, selenium and zinc) therefore treatment is best staggered so as to avoid kidney strain – one month, followed by one week’s break. Average dose: 1 to 4 grams; thrice daily.
Tea: half-1 teaspoon to cup water; bring to boil; simmer 5 minutes; infuse 30 minutes. Dose: half-1 cup, cold.
Liquid extract BHC Vol 1. 1:1 in 25 per cent ethanol. Dose: 1-4ml (15-60 drops).
Home tincture: 1 part herb to 5 parts 25 per cent alcohol (gin, Vodka, etc). Steep 14 days, shake daily. Dose: 2-5ml (30-75 drops) in water.
Poultice: “Place double handful herb in a sieve and place over a pot of boiling water (double boiler, etc). The soft hot herbs are placed between a piece of linen and applied to ulcer, adenoma, cyst or tumour.” (Maria Treben)
Bath. 9oz leaves: bring to boil in 1 gallon water. Simmer 5 minutes; strain. Add to bath water.
Enema: 1 pint weak tea for infants with kidney disorders. ... horsetail
Causes: fatigue, poor physical condition, inadequate nutrition.
Symptoms: death-like cold on surface of abdomen and under armpits, arrested pulse, slow breathing, partial loss of consciousness, blue puffy skin, stumbling, hallucinations, function of vital organs slows down.
A Glasgow survey shows cases are usually due to “the person dying of something else, drinks or drugs, or low thyroid function”. Cold induces platelet agglutination which is a hazard for sufferers of thrombosis and heart disease. Even short exposures in the elderly with atheroma (see definition) are a hazard. Preventative: Garlic.
To thin down thick blood: Nettle tea. Lemons.
Treatment. Circulatory stimulants. Under no circumstances should sedatives, antidepressants or tranquillisers be given. More than a few drops of alcohol increases heat loss and worsens the condition. Alternatives. Life Drops: 5-10 drops in cup of tea.
Cayenne pepper on food. Composition powder or essence.
Camphor drops rapidly dispel the shivering reaction. All these open surface blood vessels and promote a vigorous circulation.
Teas: Chamomile, Balm, Yarrow.
Diet. Hot meals, hot drinks, adequate protein as well as carbohydrates. No alcohol. Oats warms the blood. Oatmeal porridge is indicated for people habitually cold. One teaspoon honey thrice daily in tea or other hot drink.
Wear a hat; nightcap at night. Electric blanket. Sleep in well-heated room. Wear thick wool underclothing. Serious cases admitted to Intensive Care Unit. ... hypothermia
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