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Cogestive Heart Failure

by doris - January 10, 2010

Hi Steve,

I have a 12 year old fat Pom with Grade 5/6 holosystolic heart murmur, severe pulmonary odema and tracheal collapse. It had 2 episodes of syncopy after urination before coming to see me.

On presentation, its heart rate was fast and the chest was with severe crackles esp on Rt side. It had moist weak non-productive cough especially when excited. The tongue was bluish purple and the pulse was fast, strong and slippery . I put it on Fortekor, lasix, aminophyllin and vetmedin and do acupuncture once daily for 1 week ( the dog had symptoms of phlegm accumulation and Blood stasis, I needled LU 5 LU 9 SP 6 SP 10 ST 36 ST 40 HT 7 BL 13 BL 14 BL 15). The dog responsed reasonabily well.

At the moment, the dog has better appetite, coughing less ( still moist and non-productive), weakness on legs after urination still and chest with moderate crackles. Owner also noticed the dog has difficulty to empty the bladder fully in one go. The tongue was reddish purple and the pulse was fast, thin and slightly slippery.

I am thinking to add some herbs to the dog Should I put it on Chai Hu Jia Long Gu Mu Li Tang or Xue Fu Zhu Yu Tang? Would it be a good idea to add some Xi Miao San to clear the phlegm as well? Do I need to worry about the hypertensive effect of Chai Hu in cases of severe CHF?

Thank you for your advises

Regards,
Doris

by naturevet

January 10, 2010

Hi Doris,

Many pulmonary edema cases with advanced CHF have Heart Yang deficiency, and there is an excellent formula for that called Ling Gui Zhu Gan Tang (it would need to be made up for you, but it's a powerful herbal diuretic and cardiac stimulant). So my first thought was to try that, but I would have expected a cold dog and a pale tongue. It seems this dog has a lot of heat.

In the 'olden days', this is the type of dog that would have received digitalis. So if you fancy trying some digitoxin, I think you would reap some benefits. Basically, as I'm sure you'll remember from pharmacology, the idea is to slow the heart down such that it has better end-diastolic volume and a resultant improvement in ejection fraction and contractility.

A herbal approach that has the same general effect, but without the use of cardiac glycosides, is the use of plants rich in berberine. Berberine has been shown to have the same negative chronotropic and positive inotropic effects as a cardiac glycoside, but without the risks. You should be able to avail yourself of them by using your idea of prescribing CHJLGMLT. You can use XFXYT simultaneously, but the former is the more important one to start with. I've seen it work well in advanced CHF with pulmonary edema, and it's probably the berberine that's helping. No worries about a hypertensive effect. The net effect of the formula will be decidedly calming and 'downwards'.

Good luck and let us know how it goes!

Steve

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