It is important to note that a slow heart rate can sometimes be normal, and even a sign of good physical fitness. Healthy young adults and athletes often have resting heart rates of less than 60 beats per minute; for example, champion bicycle racer Miguel Indurain reportedly had a resting heart rate of 28 beats per minute. This occurs because high-intensity training makes the heart muscle relatively powerful. Blood travels further through arteries and veins with each contraction, making fewer contractions necessary.

But slow heart rates may also indicate heart disease. Some individuals have a slow rate because of a problem within the heart’s electrical conduction system: the heart’s natural pacemaker is not working properly or the electrical pathways of the heart are disrupted.

In severe forms of bradycardia, the heart can beat so slowly that it doesn’t supply enough blood to meet the body’s needs. This can be life-threatening and often requires a pacemaker. A pacemaker is a medical device implanted in the chest that stimulates heart contractions via small electrical impulses.

A pacemaker can keep track of the heartbeat and generate electrical signals similar to that of the heart when it is operating normally, thus causing it to beat appropriately. Ultimately, the purpose of a pacemaker is to maintain heartbeats so that adequate oxygen and nutrients are delivered through the blood to the organs of the body.

What are the symptoms?
Some people with bradycardia have no symptoms, or their symptoms are so mild that they attribute them to the normal process of aging. An inappropriately slow heart rate results in insufficient blood flow to organs and tissues, which can ultimately lead to malfunction and organ failure. The one organ most affected by lack of oxygen and proper nutrients – particularly glucose – is the brain. Poor blood supply to the brain may cause a feeling of dizziness or lightheadedness, confusion and forgetfulness, poor memory and trouble concentrating or changes in consciousness. People can faint if a slow heart rate causes their blood pressure to drop critically.

Inadequate blood supply to muscles may lead to feeling short of breath, with decreased exercise tolerance, increased fatigue, cramping or diffuse muscle pain. Chest discomfort or heart palpitations – feeling one’s heart pounding or fluttering – can also be a sign of bradycardia.

You can determine how fast your heart is beating by taking your pulse. Feel your heartbeat at the base of your neck (just under the chin or on the underside of the wrist, below the base of the thumb). Count the number of beats in a minute. If your heartbeat is slow (less than 60 – about  one beat per second, especially if you are not athletic) or uneven, talk to your doctor.

What are the causes?
The heart has its own electrical conduction system that regulates how fast and how hard it pumps. Electrical signals begin at the sinoatrial (SA) node – the heart’s natural pacemaker – located on the wall of the right atrium. Electrical signals from the SA node travel along the walls of the atria, causing atrial muscles to contract and pump blood into the lower chambers of the heart. These same electrical signals then travel to the AV node, a small area between the atria and ventricles that serves as an electrical relay station. From the AV node, these electrical signals travel along special conduction tissues to reach the walls of the ventricles, causing the ventricles to pump.

Bradycardia can result from diseases affecting the SA node, the conduction tissues, and the AV node. Sick sinus syndrome occurs when the SA node cannot generate signals frequently enough to maintain an adequate heart rate. Heart blocks of various degrees and heart failure can occur when cellular damage (due to high blood pressure and heart attacks) or age-related degeneration of the conduction system causes an impaired transmission of signals down through the heart muscle (myocardium). Certain medications can also cause bradycardia or worsen already existing disease. These include calcium channel blockers like nifedipine (Procardia) and verapamil (Calan) used for blood pressure regulation; along with digoxin (Lanoxin), used for arrythmias and to treat heart failure; and beta-blockers, such as atenolol (Tenormin) and propanolol (Inderal), used for hypertension and following myocardial infarction to protect surviving heart tissue.

The most common cause of bradycardia is degeneration of the conduction system due to aging. Thus, people are more likely to need a pacemaker as they get older, both as part of the aging process and because older patients tend to have additional medical problems that can cause slow heartbeats.

What is the conventional treatment?
If the patient has no symptoms, medical treatment may not be warranted. In some cases, the bradycardia is caused by medication, which if it can be safely stopped may cause the heart rate to normalize. However, because bradycardia is usually related to problems with cardiac conduction, the only method currently available to consistently increase heart rate is the use of a pacemaker.

Temporary pacemakers are usually used first, especially if the abnormally slow heart rate is thought to be a reversible condition that may be corrected. Temporary pacemakers are easily disconnected if the heart rate returns to normal.

Permanent pacemakers become necessary when bradycardia is believed to be a chronic or irreversible condition. Even though the overall heart rate may not be slow, pacemakers may also be used to treat fainting spells (syncope), congestive heart failure, hypertrophic cardiomyopathy, and other conditions where a controlled heartrate is desireable. It is implanted just under the skin of the chest wall in a relatively simple outpatient surgical procedure.

The pacemaker has two parts: the pulse generator and the leads. The pulse generator is implanted under the skin; it houses the battery and a tiny computer that sets the pacing of the heart and keeps track of the pulse. The leads are wires connected to the pulse generator that are threaded through the veins into the heart and implanted into the heart muscle. They send impulses from the pulse generator to the heart muscle, as well as sensing the heart’s electrical activity. When the heart beats normally, the pacemaker does nothing; however, if the heart stops beating or slows down, the pacemaker can take over at the selected rate. Typically, most implantable pacemakers have a battery that can last 10 to 15 years. The leads are relatively resistant to damage and pose little risk for infection or damage to heart tissue.

There are different types of pacemakers: single-chamber pacemakers use one lead in the upper chambers (atria) or lower chambers (ventricles) of the heart; whereas a dual-chamber pacemaker uses one lead in the atria and one lead in the ventricles. A biventricular pacemaker uses three leads: one placed in the right atrium, one placed in the right ventricle, and one placed in the left ventricle. Your doctor will decide what type of pacemaker you need based on your heart condition.

Remember, most household electrical appliances do not interfere with pacemakers; however, it is important to know which devices can cause interference with pacemaker signals. MRI machines and all magnetic devices that generate a strong magnetic field should be avoided. Cell phones can interfere with older style pacemakers and should be carried and used on the side of the body opposite to the side in which the pacemaker is implanted. Theft detector gates in stores can be a problem if individuals with pacemakers stand at or near them for long periods of time, but are probably not a problem if one walks quickly through them. Metal detectors at airports as well as handheld security wands can cause interference since they also generate magnetic fields. Individuals with pacemakers should present their ID card to security officers and walk around the gates. In pacemakers with older circuitry, high-powered electrical tools and running car engines can cause disturbances in electrical activity; although most patients can drive a car, they should not lean over a running engine. Patients should check with their physicians if unsure about operating machinery or driving.

What therapies does Dr. Weil recommend for abnormal heart rhythm?
Nutritionally, Dr. Weil recommends an anti-inflammatory diet to anyone with cardiovascular disease, including daily Omega 3 fatty acid supplements, and eating two to three servings of fish – particularly oily species such as salmon or sardines – per week.

In addition, follow your doctor’s recommendations for heart health – quit smoking, watch your diet, and begin getting regular exercise. Control risk factors by working to address high blood pressure, diabetes and atherosclerosis, and reduce stress (the hormones released by the body in response to stress, anxiety and depression make the heart work harder). Practice relaxation techniques, volunteer, and seek positive social interactions. The Relaxing Breath can improve the oxygenation of blood and take workload off the heart.

Dr. Weil also recommends the following supplements if you are coping with heart-related issues:

• Coenzyme Q10(CoQ10). CoQ10 is a powerful antioxidant that has been shown to be beneficial for heart health by improving the utilization of oxygen at the cellular level. This nutrient is very important for the heart cells of patients with heart failure or tissue damage in the heart. CoQ10 may also help lower blood pressure.
• L-Carnitine. This amino acid is essential for energy metabolism of the heart muscle.
• Cordyceps. A medicinal mushroom that helps boost aerobic capacity and can improve the efficiency of the lungs and heart.
• Hawthorn. This herb, which should only be used under a doctor’s supervision, may increase heart-muscle strength and also act as a mild diuretic.
• D-Ribose. This naturally occurring five-carbon sugar has proven beneficial for maintaining adequate energy reserves in compromised heart tissue, and is especially recommended for those with congestive heart failure.

Be sure to discuss the use of any supplement with your doctor. Your prescription drug dosages may need to be adjusted as these other measures take effect.

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What are the symptoms?
People with anemia typically feel tired and weak. In addition, they may experience symptoms such as:

• Shortness of breath
• Dizziness
• Chest or abdominal pain
• Headaches
• Cold or numb hands and/or feet
• Low body temperature
• Pale skin
• Irritability
• Black, tarry, or bloody stools (from blood loss)
• Weight loss
• Rapid or irregular heartbeat (arrhythmia)

These symptoms occur because the tissues in organs throughout the body may not be getting an optimal supply of oxygen, and because the heart must pump harder to cycle and deliver as much of the available oxygen-rich blood as possible.

What are the causes?
There are several different classifications of anemia, depending on the cause and the characteristics that are seen when examining the RBC’s under a microscope. RBCs are made continuously in the bone marrow and normally have a 120-day lifespan in the bloodstream. Anything that accelerates their loss or slows their production can result in anemia.

• Blood loss: This is the most common cause of anemia, and occurs when a person loses a significant amount of RBCs through bleeding. Blood loss can be caused by heavy menstrual periods, surgery, traumatic injury, cancer, and bleeding in the digestive or urinary tract.
• Low RBC production: The body requires certain nutrients to produce RBCs, including iron, folic acid, and vitamin B12. If a person doesn’t get enough of these nutrients, insufficient numbers of new cells are produced and anemia can result. Chronic kidney disease, cancer, infections, radiation therapy, some medications, and even pregnancy can also suppress the normal activities of the bone marrow and decrease RBC production.
• High RBC destruction: Some inherited blood disorders can destroy RBCs at a rate faster than the body can replace them. These conditions include sickle-cell anemia and thalassemia.

Who is likely to develop anemia?
Anemia is considered widespread and affects an estimated three million Americans. It is most common in women, primarily because of menstrual blood loss and pregnancy; older adults, who are more likely to have nutritional deficiencies or chronic conditions that cause anemia; and children younger than age two. Risk factors for anemia include:

• Diets low in iron, folic acid, and/or vitamin B12
• Blood loss
• Chronic infections
• Conditions such as cancer, HIV/AIDS, inflammatory bowel disease, and liver or kidney disease
• Family history of inherited anemia

How is anemia diagnosed?
A doctor can diagnose anemia by performing a physical examination, asking questions about the patient’s symptoms and medical and family history, and performing a variety of blood tests. These tests may check the size and number of RBCs, hemoglobin, and level of iron, folic acid, and vitamin B12. The doctor may also conduct further tests to identify sources of bleeding or diagnose chronic illnesses that can cause anemia.

What is the conventional treatment?
The goal of treatment is two-fold. The first objective is to increase the blood’s capacity to carry oxygen throughout the body, which is done by increasing the number of RBCs and hemoglobin to normal levels. The second goal is to diagnose and treat the underlying cause of anemia, if possible. The source of any suspected blood loss should always be determined before initiating therapy.

The conventional therapies used to treat anemia depends on the condition’s cause, severity, and nature, and can include:

• Supplemental iron to correct deficiency
• Supplemental folic acid and vitamin B12 to correct deficiency
• Antibiotics to treat infections
• Erythropoietin (Procrit) to increase RBC production in people with kidney disease
• Hormonal treatments to decrease heavy menstrual bleeding
• Blood transfusions
• Removal of the spleen to slow RBC destruction

What therapies does Dr. Weil recommend for anemia?
It’s vital to recognize that nutritional advice on iron has changed. As recently as the 1970s, the conventional wisdom was that iron is a tonic, and should be taken by virtually everyone to counteract fatigue and “tired blood.”

But more recent research suggests caution. Iron is a strong oxidant and can potentially promote the development of inflammatory conditions, including heart disease. Iron is also one of the few minerals that the body cannot readily eliminate, and overconsumption can make it accumulate to toxic levels. This is especially true of people with an inherited disease called hemochromatosis, or iron overload disease, which is believed to affect as many as one million Americans. So unless you are a menstruating woman, have had significant blood loss, or have otherwise been determined by a physician to be an appropriate candidate for iron supplementation, you should not take any supplement containing iron or otherwise take extraordinary steps to boost your iron intake. If supplemental iron is advised by a physician, you can take an over-the-counter iron supplement. Dr. Weil recommends a highly absorbable form of iron known as iron gluconate.

With that in mind, Dr. Weil suggests the following strategies for addressing mild to moderate cases of iron-deficiency anemia. These should be considered in addition to conventional therapy that addresses the root cause of anemia:

• Cook in cast-iron pots (the cooked food absorbs iron).
• Increase intake of red meat (preferably organic), chicken and fish, all of which provide some iron. Vegetarian sources include whole grains, dried beans, molasses, dried apricots and prunes, and leafy green vegetables such as kale, beet greens and chard, as well as exotic greens such as dandelions, lamb’s quarters, nettles and yellow dock.
• Eat more foods that enhance iron absorption. These include fruits and vegetables high in vitamin C, or yogurt or sauerkraut, both of which contain lactic acid, which promotes iron absorption. Fermented soy foods can aid absorption as well.
• Avoid caffeinated beverages, eggs, milk and bran, all of which can interfere with iron absorption.

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Angina, or angina pectoris, is chest pain that follows a decrease in the blood supply to the heart, an increased demand for oxygen by the heart, or a combination of both. It is a classic symptom of coronary artery disease and sometimes predicts heart attacks.

What are the symptoms of angina?

The single most important symptom is chest pain brought on by physical activity or exercise. This usually feels like pressure, fullness, or a squeezing pain in the center of the chest, but can also resemble indigestion. Sometimes, the pain radiates to the neck, along the left shoulder or down the left arm into your jaw or back. Other symptoms may include difficulty breathing and nausea. There are three types of angina:

• Stable. This is the most common type. It occurs when the heart is working harder than usual. The pain usually goes away with a few minutes of rest or with medication. Most people who have stable angina learn to recognize the pattern or warning signs and anticipate when it will occur. Attacks usually last five minutes or less.
• Unstable. An attack of unstable angina is dangerous and requires emergency medical evaluation and treatment; it can be a sign that a heart attack is imminent. This type of angina follows no pattern, can occur in the absence of physical exertion and is not relieved by rest. Attacks can last up to 30 minutes.
• Variant. A rare type, variant (or Prinzmetal’s) angina is due to a spasm that tightens coronary artery walls thus slowing or stopping blood flow to the heart. Attacks usually occur at rest, most often between midnight and early morning. The pain can be severe.

What are the causes of angina?

The underlying problem is narrowing of the coronary arteries due to atherosclerosis, the build-up of cholesterol-laden plaque on the inner lining of artery walls. The build-up is believed to originate with an injury to the vessel wall and subsequent inflammation. In response to the injury, white blood cells, along with cholesterol, begin to accumulate along the inner layer of the artery. The muscle layer of the artery may also enlarge, forming the basis of a plaque, which can grow large enough to narrow and eventually block the artery. As a result of the narrowing, blood flow through the artery isn’t sufficient to meet the heart’s higher demand for oxygen (carried in blood) during exercise. Angina can also be caused by spasms that temporarily constrict an artery and slow blood flow. Some attacks are triggered by emotional or physical stress, exertion after a meal or even extreme changes in temperature. The nicotine from tobacco use can directly affect blood vessels and bring on angina.

What is the conventional treatment of angina?

Conventional medicine treats angina with drugs (nitroglycerin, nitrites, nitrates) [moved] that relax and widen arteries so that more blood can flow to the heart, or with other medications (beta-blockers, calcium-channel blockers) that reduce the workload of the heart. Although these drugs can relieve the symptoms, they don’t alter the underlying problem. What’s more, all of these medications can cause serious side effects. The other standard approaches to treatment are angioplasty, a procedure using a small inflatable device (a “balloon”) to open blocked or narrowed arteries, installing a stent, and coronary bypass surgery in which blood vessels taken from other areas in the body are used to route blood around (bypass) blockages in coronary arteries. All of these interventions are very expensive, drastic procedures that may provide temporary relief but do not halt progression of disease.

What therapies does Dr. Weil recommend for angina?

Lifestyle changes can help reverse the coronary artery insufficiency that leads to angina. These include following a heart-healthy diet, mind-body techniques including yoga and mediation, group therapy and moderate exercise. If you smoke, quit.

To slow or reverse the atherosclerosis that underlies angina:

• Get more exercise. This will help maintain the health of the vessels leading to the heart, as well as strengthen the heart muscle itself.
• Control cholesterol.
• Stop smoking, and avoid secondhand smoke.
• Control your blood pressure.

The following supplements can also help:

• Coenzyme Q10 (CoQ10). This powerful antioxidant can benefit heart health by influencing the mitochondria, the tiny powerhouses found in heart cells and in cells throughout the body, which is where energy metabolism occurs. In this way, CoQ10 may help lower the heart’s oxygen demands by improving its energy efficiency. It may also help lower blood pressure. The dose is 60-100 mg a day.
• Hawthorn (Crataegus oxycantha). This herbal preparation made from the leaves and flowers of a species of hawthorn tree may help relieve angina symptoms by increasing coronary artery blood flow. The starting dose is 500 mg a day of an extract of the leaves and flowers standardized to 2% vitexen-2 rhamnoside. NOTE: Hawthorn should only be used under the supervision of a physician.
• L-carnitine. Theamino acid, l-carnitine can help relieve angina symptoms by improving heart muscle metabolism. The recommended dose is 1,000 mg twice a day.
• Fish oil. The omega-3 fatty acids in fish and fish oil supplements have been shown to be an effective preventive strategy against heart disease. They can lower triglyceride levels, increase HDL cholesterol, help minimize inflammation and blood clotting, and keep blood vessels healthy.

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