Integrative Approach to Cardiovascular Disease

Integrative Approach to Cardiovascular Disease

Kristina M. Erwin


Congestive Heart Failure (CHF) is commonly seen in veterinary practice. Understanding the pathophysiology from a conventional and Traditional Chinese Veterinary Medicine (TCVM) viewpoint allows the practitioner to identify multiple pathways for intervention to help stabilize the patient and improve quality of life. An integrative, multi-modal approach including conventional drugs, herbal medicine, acupuncture, rehabilitation, nutrition, and husbandry care further helps to address the primary disease as well as other co-morbidities that often occur with CHF. These techniques can benefit CHF patients throughout the course of their illness from initial diagnoses through to hospice and end-of-life care.

Pathophysiology of Congestive Heart Failure (Conventional)

Congestive heart failure (CHF) is a complex clinical syndrome arising from structural or functional impairment of ventricular filling or ejection of blood. Decreased cardiac output (CO) causes lower blood velocity and blood to pool. Left sided heart failure leads to congestion in the lungs with edema while right sided failure leads to systemic venous congestion and peripheral edema or ascites. Decreased CO also causes decreased renal blood flow and GFR, leading to further sodium and fluid retention [1]. These physiological changes lead to neuro-hormonal responses that increase vasoconstriction and peripheral vascular resistance to try to improve circulation. The heart rate increases to compensate for decreased CO and the heart chambers may dilate or the muscle itself may hypertrophy. The result is increased sympathetic nervous system activation [1].

Clinical signs of CHF include dyspnea, cough, exercise intolerance, sarcopenia, and collapse. Affected animals progress through three stages of increasing severity with clinical signs for Class I only apparent during vigorous exercise, Class II seen during minimal exercise and Class III animals affected even at rest [1]. Conventional treatment depends on disease severity with prognosis for these patients greatly improved by the availability of newer pharmaceutical drugs as well as the expertise of veterinary cardiologists (Table 19.1).

Table 19.1  Common pharmaceuticals for management of CHF (Note: Please check a current veterinary formulary for the most up to date recommendations for dosage and administration).

Pharmaceutical effect Example
Phosphodiesterase (PDE) III selective inhibitors


Note: Administer tablets at least one hour before feeding as absorption is reduced when administered with food.

ACE inhibitors



B-Adrenergic receptor blockers/antagonists



Loop diuretics Furosemide
Aldosterone antagonists Spironolactone
Pyridine-sulfonyl urea type loop diuretics Torsemide
Selective phosphodiesterase V inhibitors Sildenafil
Methylxanthine drugs Theophylline
Cardiac glycosides Digoxin



Na-channel blockers Mexiletine
Ca-channel blockers Diltiazem
Nutritional supplements




Pathophysiology of Congestive Heart Failure (Traditional Chinese Veterinary Medicine)

An understanding of CHF from a TCVM viewpoint can further give the practitioner opportunities for supporting patients and improving quality of life. In TCVM, the Heart is considered the Emperor of the body and it governs Blood circulation, houses the Shen (spirit), and controls sweating [1, 2]. Heart Qi supplies the power to pump blood through the body, and the Heart, Lung and Liver all play a role in circulating the Blood. The Heart (and Lung) make Blood from nutrients provided by the Spleen. The Blood is the root of the Shen and the Heart/Blood complex directly affects the mental activities of memory, thinking, and sleep. In health, the Shen will be balanced, peaceful, and joyful. If the Shen is deficient, mental activities are weak and anxious [1, 2].

There are six TCVM Heart Patterns involving Qi, Yin, and Yang (Table 19.2) and 2 TCVM Patterns involving Zang-fu organ imbalance (Table 19.3).

Table 19.2  Heart TCVM pattern differentiation and treatment [1]. Xie, H et al., 2013; [3]. Beebe, S. 2009.

TCVM pattern Etiology Clinical signs Treatment goals Treatment options
Heart Qi-blood stagnation Excess or deficiency (upper-Jiao), causes blood stagnation or sluggish circulation; blocks heart Qi Painful back/chest, restless, deep-slow pulse, tongue-grey/purple with petechia; Class I disease Eliminate stagnation/pain, activate Qi-blood Compound Dan Shen a
Heart Qi deficiency Weakened heart (e.g. age, sick, congenital), poor circulation, stagnation with damp accumulation Shortness of breath, lethargy, pale-tongue, weak-irregular pulse Tonify Heart Qi Heart Qi tonica
Heart Yang deficiency Cold with Qi deficiency, stagnation with phlegm obstruction Shortness of breath, lethargy, loose stool, cool body, pale/ purple-tongue, weak-irregular pulse Tonify Heart Qi and warm Yang, strengthen Heart, eliminate cold Bao Yuan Tang
Heart and Kidney Yang deficiency Kidney Yang deficiency leads to heart Yang deficiency; Shao Yin pathogens Ascites, edema rear limbs, cool back/limbs, slow-superficial-toneless pulse, tachycardia Tonify Kidney and Heart Yang, warm the Yang Zhen Wu Tang, Epimedium 8 formulab
Heart Yin and Qi deficiency Qi-Yin damaged, weak Kidney Yin affects fluid balance = increased blood viscosity, false heat encourages phlegm obstruction/stagnation, Qi deficiency weakens heart Pain in chest exacerbated by moving; dizziness; red tongue; weak-irregular pulse Tonify Heart Qi and Yin, activate Blood, regulate pulse

Sheng Mai San,

Yi Guan Jian

Collapse of Yang Qi Extreme progression of Heart Qi and Yang deficiency with syncope or coma Coldness limbs/back, urine retention, blue-purple tongue, feeble pulse Revive Yang to resuscitate collapse Shen Fu Tang

a Dr Xie’s Jing Tang Herbal Inc, Ocala, FL. USA.

b Seven Forests Herbal Formulas, Institute for Traditional Medicine (ITM), Portland, OR. USA.

Table 19.3  Heart TCVM patterns involving Zang-fu organ imbalance [2].

TCVM pattern Etiology Clinical signs Treatment goals Treatment options
Wood-Metal imbalance Cycle of Qi not moving into Lung, fluid accumulation, prevents Blood production, creates Qi stagnation Pulmonary edema, harsh chronic cough (worse 3–5 AM); thin-weak pulse, lavender tongue, cool extremities Move Qi and Blood, tonify Blood Xue Fu Zhu Yu Tang*
Shao Yang disharmony Excess: Yang trapped internally, Qi-blood trapped in Lung, hindering circulation to periphery Pulse becomes hard, internalized Chai Hu Jia Long Gu Mu Li Tang #
Deficient: Yang trapped in upper-Jiao and on body surface; Fluids cannot descend from Lung to Kidney, Yin and Yang cannot integrate, source Qi cannot be made.

Pulses: superficial, slippery to toneless

Tongue: red, purple red, or dark red.

* This formula increases peripheral blood flow, which reduces heart workload; helps clear hilar edema, acts as anti-tussive

# This formula can be added to heart failure patients with severe pulmonary congestion.

Integrative Therapy

Because CHF is a medically complex disease and most patients are clinically fragile, it is helpful for practitioners to approach case management from a broad perspective. Integrative therapies can improve quality-of-life (QOL) and outcomes for CHF patients. Practitioners should work to match treatment recommendations to client goals, patient tolerance, and the patient’s overall clinical status. Treatment recommendations should be revisited frequently to ensure they are appropriate as the case evolves and changes.

Botanicals for Cardiovascular Support

Hawthorn (Crataegus spp.)

Actions: Mild positive inotrope; anti-arrhythmic; antiplatelet aggregation; vasodilating; endothelial protective; decreases arterial blood pressure; antioxidant [4].


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Jul 30, 2023 | Posted by in ANIMAL RADIOLOGY | Comments Off on Integrative Approach to Cardiovascular Disease

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