Acupuncture treatment for heart disease.
- The Pathophysiology of Coronary Heart Disease ( CHD )
The Heart requires a continuous supply of blood to work properly and it gets this via the coronary arteries. The right coronary artery supplies both the left and the right heart; the left coronary artery supplies the left heart.
Coronary Heart Disease is as stated by The British Heart Foundation ( 2015 ), a condition caused by the narrowing of your arteries by a build-up of fatty material on the artery walls. The material is called Atheroma (from the Greek athera (porridge) and oma (lump)) and the condition is Atherosclerosis. Atheroma is often referred to as Plaque.
The image above shows a healthy artery with no Atheroma and below that a partially blocked artery with a build up of Atheroma. Chilton ( 2004 ) explains that the Atheroma is constructed from macrophages and T cells embedded in a thin layer of lipids on the arterial wall. The macrophages engulf the lipids and become activated foam cells, these then release various chemoattractant molecules, cytokines, and growth factors which results in attracting more lymphocytes.This perpetuates the inflammatory response and as the cycle repeats the structure is stabilized by the plaque developing a fatty core covered by a fibrous matrix.
As the volume of plaque develops the flow of blood through the arteries is gradually restricted until it reaches the stage where not enough blood is being delivered to the heart. This is where the onset of pain is experienced. The British Heart Foundation ( 2015 ) continues to explain that if a piece of the plaque breaks off it can cause a complete blockage of the artery (a blood clot) and result in a heart attack. Chilton (2004) confirms that 70% of all fatal acute myocardial infarctions and sudden coronary deaths are attributable to plaque rupture or plaque erosion.
- In Marie’s case she might have been at particular risk of developing coronary heart disease due to her modifiable and unmodifiable risk factors. Firstly Marie has been diagnosed with Type 2 diabetes.
According to Stephenson ( 2011 ) people with diabetes are more prone to both atherosclerosis and arteriosclerosis. Partly due to high sugar levels on the walls of the blood vessels and the likelihood of raised blood lipids. Diabetes UK ( 2015 ) states that with Type 2 Diabetes there is either not enough insulin or the insulin is not functioning correctly so cells are only partially unlocked and glucose builds up in the blood. If the correct function of insulin is missing then the cells can not use up the glucose as energy which results in the high sugar levels and increased risk of atherosclerosis and arteriosclerosis.
Marie’s has the unmodifiable risk factor of family history. Her mother having passed away from a heart attack. According to Khaw and Barrett-Connor (1986)
numerous studies concluded that a family history of heart disease has been reported to increase the risk of Coronary Heart Disease by two to sevenfold. The U.S National Institute of Health (2015) however does not completely concur with this statistic and states that it is a far more complex situation depending on the modifiable risk factors of both the parent and the child. For example Marie’s mother could have been a heavy smoker whilst Marie is a non-smoker. Stephenson (2011) agrees with Khaw and Barrett-Connor (1986) and states that the risk of developing Coronary Heart Disease is greater if there is a family history of Coronary Heart Disease. In conclusion I feel that this is a very closed statement and all non-modifiable risk factors of both the parent and child need to be considered before this can be categorical.
A further modifiable risk factor that Marie exhibits is her high blood pressure. Marie’s blood pressure is 165 / 98 mm Hg. As you can see from the diagram below this is firmly in the High Blood Pressure region.
The World Heart Federation (2015) explains that having high blood pressure causes stress on the blood vessels resulting in weakening them or clogging. It can lead to the blood vessels narrowing and a decreased rate of blood flow to the heart also leading to atherosclerosis.
Maries diet is another modifiable risk factor which could be contributing to her risk of Coronary Heart Disease. Whilst we don’t know specifically what her diet is like we know two factors. One is that her husband describes it as unhealthy and the second is that she was renowned for her pastry dishes which we can assume she also consumed regularly. Stephenson (2011) explains about foods which are preventative against Coronary Heart Disease. These include healthy fats such as vegetable, olive and fish oils, foods that provide vitamins A, C and E and also fresh fruits, vegetables and garlic. Also the regular consumption of low levels of alcohol also can be protective, especially red wine due to its flavonoids and alcohol. Conversely a diet high in cholesterol will increase the risk of Coronary Heart Disease and pastry dishes will certainly contribute to Marie’s cholesterol levels.
Finally Maire’s modifiable lifestyle habits regarding stress can be contributing to her risk of Coronary Heart Disease. According to the US National Institute of Health (2015) stress and emotional worry can raise your blood pressure and increase your risk of a heart attack. Stress is also more likely to make you eat an unhealthy diet and again therefore contribute again to the risk factor.
- Initial investigations of a patient with chest pain at the GP surgery.
| Questions Asked by the GP / examination done by the GP. | Comparison of :- | |
| Stable Angina | Myocardial Infarction | |
| How often does the pain occur? | Occurs when engaged in physical activity or at times of increased emotional stress. | Can Occur at any time. |
| What does the pain feel like? | Tightness or pressure. | Severe Pain, described as crushing and steady. |
| Where is the pain located? | In the chest, and may radiate to the neck, lower jaw, left arm, and left shoulder. | In the chest radiating to the left side of the neck. |
| How long does the pain usually last for? | Usually lasts for three to five minutes with the chest discomfort lingering for up to fifteen minutes. | Chest pain can last for more than 15 minutes. |
| What makes the symptoms improve? | Improves with rest. | |
| Other symptoms when pain occurs. | Breathlessness, chest tightness without pain ( in the elderly ) | Breathlessness, chest tightness without pain ( in the elderly ) cold sweat, vomiting. |
| Physical Tests | Blood Pressure test done | Blood Pressure test done |
| Physical Tests | Weight and waist size measurement | |
| Physical Tests | Blood and Urine Tests. | |
For further testing a GP will then refer the patient to a specialist.
- Marie’s Acupuncturist April Fitzpatrick has summoned an ambulance for Marie because she is exhibiting signs and warning features of serious disease. Whilst sitting in the waiting room for her appointment Marie is presenting with the following symptoms. She is distressed, breathless and sweating profusely. She is complaining of severe pain in her arm and chest which is not subsiding after taking her medication and after resting for a few minutes and she is feeling nausea. April will be concerned that she is exhibiting early signs of Myocardial Infarction. Stephenson (2011) states that severe chest pain that is radiating to her arm and not subsiding is suggestive of cardiac pain. Also that as Marie is 67 and presenting with breathlessness, sweating profusely and is nauseas this can also be signs of a heart attack. Clearly these are Red Flags to an Acupuncturist who should refer the patient to the hospital immediately.
- Echocardiogram
The British Heart Foundation (2015) explains that an Echocardiogram uses sound waves to create a picture of your heart. Very similar to an ultrasound as used in pregnancy. The Echocardiogram looks at the structure of your heart and the heart valves and provides information on the pumping action of your heart and how the heart is functioning. There are several types of echocardiogram and the doctor will chose which one is most appropriate depending on the circumstances.
Transthoracic echocardiogram. The test is performed by placing a probe on different areas of your chest. This will give off pulses of high frequency sound waves which pass through your skin to your heart. The ultrasound waves that are produced by the machine ‘echo’ against the structures of your heart which is then transferred to an image on the echo machine. The probe will be moved around in order to view different areas of your heart. The Machine can also show areas of reduced blood flow to the heart. Transesophageal echocardiogram. If it is not possible to obtain a clear enough image from the surface of the chest then a transesophageal echocardiogram is used. In this procedure, a flexible tube containing a transducer is guided down your throat and into your esophagus so that a closer image can be obtained. Doppler echocardiogram. When sound waves bounce off blood cells moving through your heart and blood vessels, they change pitch. These changes (Doppler signals) can help your doctor measure the speed and direction of the blood flow in your heart. Stress echocardiogram. A stress echocardiogram is used when heart problems only occur during physical activity. To complete this test the patient is commonly asked to walk on a treadmill and then the echocardiogram is completed.
Blood Tests
The Mayo Clinic (2014) explains that a blood test that is carried out in order to measure the risk of Coronary Heart Disease measures various elements within the blood. These include Cholesterol, C-reactive protein, Fibrinogen, Lipoprotein and Natriuretic Peptides. Cholesterol is measured to monitor the various elements within cholesterol; Low-density lipoprotein (LDL) cholesterol. High-density lipoprotein (HDL) cholesterol. Triglycerides and total Cholesterol. Total cholesterol. This is a sum of your blood’s cholesterol content. A high level can put you at increased risk of heart disease. Low-density lipoprotein (LDL) cholesterol. Too much of it in your arteries can cause atherosclerosis, which reduces blood flow. High-density lipoprotein (HDL) cholesterol. This helps to carry away Low Density Lipoprotein cholesterol. Triglycerides. These are another type of fat and high levels of these increase your risk of coronary heart disease.
C-reactive Protein is produced by your liver for the inflammatory response to injury. Inflammation plays a central role in atherosclerosis. Results that show high levels of C-reactive protein when used with other results could aid the diagnostician when looking for heart disease. Although the levels do not indicate where the inflammation is in the body. Fibrinogen is a protein that helps blood to clot. If there is too much fibrinogen present then there is a greater risk of clotting in the arteries. Lipoprotein is a type of cholesterol and high levels may indicate a risk to coronary heart disease. Natriuretic peptides is a protein that your heart and blood vessels produce which helps your body eliminate fluids, relaxes blood vessels and funnels sodium into your urine. High levels can be an indication of heart failure and other heart conditions.
- The TCM interpretation of Angina.
According to Stephenson (2011) Traditional Chinese Medicine interprets Angina as Heart Blood Stagnation. The symptom of intense pain in the chest and the understanding that Atheroma very frequently underlies angina suggests that the patient also has signs of Phlegm and Zong Qi Deficiency. Maciocia (2005) confirms this and describes Heart Blood Stagnation manifesting physically as a stabbing pain in the chest that may radiate to the left arm.
Two Complimentary therapies.
Acupuncture is a therapy that would complement any conventional treatment that Marie may receive for Angina. A TCM acupuncturist would be able to diagnose Marie’s present condition and treat not just the Heart Blood Stagnation that she is currently experiencing but also the underlying patterns that may be causing the syndrome in the first place. A Five Element Practitioner of Acupuncture could also treat Marie’s Constitutional Factor and emotional state. This will not only help her to heal physically but also help her mentally and spiritually to deal with the on going situation. According to Healthcare Medicine Institute (2013) the Department of Nuclear Medicine at Peking University Shenzhen Hospital successfully measured improvements in blood flow to the heart for patients with coronary heart disease using Acupuncture treatment.
Qi Gung is a therapy that would complement any conventional treatment that Marie may receive for Angina. The London School Of Tao Arts (2015) states that effective relief for the condensing and compression of the arteries experienced with Coronary Heart Disease is basic energy boosting exercise. They continue by suggesting Proper postural alignments, Lengthening exercises and Deep, diaphragm breathing. They suggest that proper bodily alignments will take the kinks out of arteries and veins and extend the soft tissues of the body all improving blood flow to the heart. This in conjunction with deep diaphragm breathing will improve circulation throughout the entire body. Alt MD (2015) states that a Chinese study that included women with coronary heart disease found significant reductions in the frequency and severity of angina attacks as well as a lowering of blood pressure following a course of qigong exercise.
Acupuncture treatment will fit in smoothly with any ongoing treatment regime devised by a conventional medical practitioner. Marie could have treatment once a week. As long as the practitioner and Marie communicate fully regarding the medication and treatment that she is receiving there are no foreseeable issues. The practitioner will need to fully understand the desired effects of the medication and ensure that the Acupuncture treatment given does not conflict with these effects. With this considered the acupuncture treatment will also be able to help with any side effects that manifest from taking the western medication.
Qi Gong will fit in easily with any ongoing treatment regime devised by a conventional medical practitioner. Marie will be able to practice Qi Gong as freely as she desires with no effect on her western medicine treatment.
References
Blood Pressure UK. Image 3. Blood Pressure Chart [online] Available from:
http://www.bloodpressureuk.org/BloodPressureandyou/Thebasics/Bloodpressurechart [accessed Sept. 2015]
British Heart Foundation ( 2015 ) [online] Available from:
https://www.bhf.org.uk/heart-health/conditions/coronary-heart-disease [accessed Sept. 2015]
Chilton, Robert J. 2004. The Journal of the American Osteopathic Association, Vol. 104, 5S-8S. US.
Diabetes.Org. What is Diabetes [online] Available from: https://www.diabetes.org.uk/Guide-to-diabetes/What-is-diabetes/What-is-Type-2-Diabetes/ [accessed Sept. 2015]
Healthcare Medicine Institute (2013) Acupuncture for CHD[online] Available from:
http://www.healthcmi.com/Acupuncture-Continuing-Education-News/1206-acupuncture-for-coronary-heart-disease-new-discovery [accessed Sept. 2015]
Khaw and Barrett-Connor (1986) Family history of heart attack: a modifiable risk factor? [online] Available from: http://circ.ahajournals.org/content/74/2/239.full.pdf
Lamaison Medicale. Angiology Image 2. Atheroma [online] Available from:
http://www.lamaisonmedicale.co.uk/menus/angiology_phlebology.php?lang=uk [accessed Sept. 2015]
London School Of Tao Arts (2015) Qi-gong [online] Available from: http://www.circlewalking.com/3965/healing-qigong/ [accessed Sept. 2015]
Nlm. Medicine Plus Image 1. Coronary Arteries [online] Available from:
https://www.nlm.nih.gov/medlineplus/ency/presentations/100160_1.htm [accessed Sept. 2015]
Stephenson.C, (2011) The Complementary Therapists Guide To Conventional Medicine London: Churchill Livingstone
US national Institute of Health ( 2015) Coronary Heart Disease Risk Factors [online] Available from:
http://www.nhlbi.nih.gov/health/health-topics/topics/hd/atrisk [accessed Sept. 2015]
copywright: Jon Walsh
