Pathophysiology, Risk Factors, and Management of Chronic Heart Failure

Chronic Heart Failure: Pathophysiology, Risk factors, and Mechanisms is the first of two separate but closely related volumes which aim to provide an inclusive overview on Chronic Heart Failure (CHF).

This first volume is focused on the epidemiology, classification, molecular mechanisms, pathophysiology, causes, identification and interactions of heart failure. It will explain the uncertainties and issues in Heart Failure by helping readers understand the physiopathology of CHF in the light of behavioural risk factors. 2D and 3D speckle tracking echocardiography have been used to quantify regional alterations of longitudinal strain and area strain, through their polar projection, which allows a further evaluation of both the site and extent of myocardial damage. The analysis of strain can identify subclinical cardiac failure (myocyte remodelling) which is a major issue in CHF. Myocardial Strain, measure by speckle tracking echocardiography, is frequently attenuated in these conditions and can be utilized for the evaluation of disease progression and the effect of therapeutic interventions as well as prevention because it could be a manifestation of behavioural risk factors.

These 2 separate volumes serves as essential references to both researchers and practicing clinicians, proposing novel methods of research by using behavioural and environmental risk factors as intervention agent, as well as discussing deficiency in the present approaches in management of HF and proposing new methods of early diagnosis and therapies for the clinical management of CHF.

• Includes a number new and controversial topics: Roles of both behavioural and nutritional risk factors in CHF; considering behavioural intervention which may change the remodelling, as well as nutrient supplementation or change of diet in preventing CHF or converting resistant HF in to HF responding to therapy; Evidence-based knowledge on CHF, with an emphasis on viewing CHF as a disease of the brain and contribution from other systems; Pre–Heart failure which can be prevented to restore normal cardiomyocyte function; Pathogenesis of HF in chronic kidney disease; 2D and 3D speckle tracking echocardiography
• Includes never-published tables and figures to aid understanding of the topics
• Contributions from international leading experts in the field, written with the aim of serving both researchers and practicing clinicians

• Language: English
• Publisher: Academic Press
• Release date: Apr 4, 2024
• ISBN: 9780128231111

Book preview

Section 1

History, epidemiology, and burdendue to chronic heart failure

Outline

Chapter 1 History of medicine from ancient times to present

Chapter 2 Epidemiology and mortality due to heart failure

Chapter 3 Behavioral risk factors of chronic heart failure

Chapter 4 Nutritional factors in the pathogenesis of heart failure: a review

Chapter 5 Evolution of the natural history of myocardial twist and diastolic dysfunction as cardiac dysfunction

Chapter 1

History of medicine from ancient times to present

Ram B. Singh¹, J.P. Sharma¹, Galaleldin Nagib Elkilany², Jan Fedacko³, Krasimira Hristova⁴, Ibrahim Kabbash⁵, Mohammad Ismaeil El-Shafey⁶, Shabnam Omidvar⁷, Hseam Shahrajabian⁸, Mojgan Khatibi⁹, Sara Sarrafi Zadigan⁹, Shridhar Dwivedi¹⁰, Manal M.A. Smail¹¹, Kamala K. Tripathi¹², R.G. Singh¹³, Pawan K. Singal¹⁴, Suresh Tyagi¹⁵, Hosna Motamedian¹⁶ and Daniel Pella³,    ¹Halberg Hospital and Research Institute, Moradabad, Uttar Pradesh, India,    ²Gulf Medical University, Ajnam, United Arab Emirates,    ³Faculty of Medicine, PJ Safaric University, Kosice, Slovakia,    ⁴National Heart Hospital, Sofia, Bulgaria,    ⁵Faculty of Medicine, Tanta University, Tanta, Egypt,    ⁶Faculty of Arts, University of Tanta, Tanta, Egypt,    ⁷Shabnam, Health Research Institute, Babol University of Medical Sciences, Babol, Iran,    ⁸Biotechnology Research Institute, Chinese academy of Agricultural Sciences, Beijing, P.R. China,    ⁹Endocrinology and Metabolism Center, Institute of Basic and Clinical Physiology Sciences, Kkerman University of Medical Sciences, Kerman, Iran,    ¹⁰National Heart Institute, New Delhi, India,    ¹¹Khalifa University, College of Medicine, Al Ain City, United Arab Emirates,    ¹²Institute of Medical Sciences, BHU, Varanasi, Uttar Pradesh, India,    ¹³Heritage Institute of Medical Sciences, Varanasi, Uttar Pradesh, India,    ¹⁴Institute of Cardiovascular Sciences, St. Boniface Hospital Albrechtsen Research Centre, Department of Physiology and Pathophysiology, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, Canada,    ¹⁵Department of Physiology, University of Louisville School of Medicine, Louisville, KY, United States,    ¹⁶University of Nicosia Medical School, Nicosia, Cyprus

Abstract

In the prehistoric Harrapan culture of India, before and after 2000 BCE, there was the system of medicine with professional healers, sanitation and hygiene. The people of Indus Valley Civilization, even from the early Harappan periods (3300 BCE), had knowledge of medicine and dentistry. There is evidence that teeth having been drilled, dating back 7000 BCE. India has a rich, heritage of medical and health sciences in the Vedic period, due to a separate medicinal branch of medical science Ayurveda. It was so much evolved and practiced that some scholars considered it as the fifth Veda, when Medicine was evolving in other countries. (https://shodhganga.inflibnet.ac.in/bitstream/10603/59913/6/06_chapter%202.pdf). It seems that the history of medicine including anatomy in India traces from the Paleolithic Age to the Indus Valley Civilization and the Vedic Times. However, the progress in Ayurveda declined during the Islamic Dynasties and the modern Colonial Period.

Keywords

Medicine; health; Indus Valley Civilization; Vedas; Ayurveda

Ancient history of medicine

In the prehistoric Harrapan culture of India, before and after 2000 BCE, there was the system of medicine with professional healers, sanitation and hygiene. The people of Indus Valley Civilization, even from the early Harappan periods (3300 BCE), had knowledge of medicine and dentistry. There is evidence that teeth having been drilled, dating back 7000 BCE. India has a rich, heritage of medical and health sciences in the Vedic period, due to a separate medicinal branch of medical science Ayurveda [1]. It was so much evolved and practiced that some scholars considered it as the fifth Veda, when Medicine was evolving in other countries [2–5]. (https://shodhganga.inflibnet.ac.in/bitstream/10603/59913/6/06_chapter%202.pdf). It seems that the history of Medicine including anatomy in India traces from the Paleolithic Age to the Indus Valley Civilization and the Vedic Times [1,6–9]. However, the progress in Ayurveda declined during the Islamic Dynasties and the modern Colonial Period.

Vedas and Upanishads are considered most ancient books in the history of mankind [1,4]. There are four kinds of Vedas; Rig Veda, Sham Veda, Yajur Veda, and Athar Veda. The translation of Vedas is called Upanishads. Among all known books, Rig Veda is supposed to be the first book of mankind and Athar Veda as the first book on Medicine possibly from 5000 BCE [1,4]. The following lyrics in Sanskrit are believed to be inspired from the Brihardarpanyaka Upanishad, verse 1.4.14 composed by Yajnavalkya, an ancient Indian philosopher of 9th century BCE [1]. It is given below in Sanskrit with recitation in Sanskrit, followed by the meaning in English. It is clear from this verse that happiness and healthiness as characteristics of health were known to Indians from the ancient time. It is accepted as doctor’s prayer, by the Indian Medical Association.

Rishi (Professor Emeritus) Dhanvantari the First Physician of mankind is the Hindu god of Medicine and an incarnation of Lord Vishnu. In the Indian Puranas, he is mentioned as the God of Ayurveda, who brought wisdom of Ayurveda for health of mankind. He, during the Samudramanthan (Churning of the Ocean) arose from the Ocean of Milk with the nectar of immortality, which may be medicine for health and longevity. In Hinduism, it is common for worshipers to pray to Dhanvantari seeking his blessings for sound health for themselves and/or others, especially on Dhanwantari Trayodashi. The Indian Government has declared that Dhanwantari Trayodashi Kumara, every year, would be celebrated as National Ayurveda Day (Fig. 1.1).

Figure 1.1 Rishi Dhanvantari, the God of Ayurveda in India, appeared, during Churning of the Ocean (5000 BCE). https://en.wikipedia.org/wiki/Samudra_manthan

Bhagavad Gita and health

Much before the development of civilizations in Greece, Egypt, China, and Mesopotamia including Babylonia, several statements were made by ancient preachers about life and Medicine in India, which are mostly derived from Vedas and Upanishads [1–5]. Lord Krishna as human being was master of 24 arts of Vedas and is worshiped in India as God. He made several statements in ancient period, which are considered most recent in modern Medicine. Lord Krishna gave a lucid description of mind, and diet in the context of health and diseases, in the ancient scripture Bhagavad Gita (3000 BCE) [9] (Fig. 1.2).

Figure 1.2 Lord Krishna narrates Bhagavad Gita verses, to Prince Arjuna (Bhagavad Gita 3000 BCE) [9]. Modified from Google.

India appears to have a heritage of knowledge dating back to 8000 BC from sages and saints who perceived various aspects of nature and universe, experienced their observations, and transmitted their findings through the Vedas and Upanishads [1–4,6–9]. The knowledge was transferred from one generation to another by recitation and verbalization in ancient schools [1,4,6,7]. The first two lines in each of the four verses are in Sanskrit followed by its English translation [8,9].

Aayuh satvabalarogyam, sukhpreetiviverchanah

Rasyah snigdhah sthirah hradyah aharah satvikpriyah [1].

The sattvic foods are full of juice, good in taste and increase longevity, wisdom, power, health, happiness, peace, and love.

Yktaharviharasya, yuktachetasya karmasu

Yktaswapnavbodhasya, yogo bhavati duhkhaha [1].

Yoga is protective against grief to those who have disciplined diet and lifestyle and controlled behavior; sleep and awakening.

Katvamlalavanatyusnteekshanaruksha vidahinah

Ahar rjassyestah, dukhahshokmaypradah [1].

The foods that are bitter, acid, fried, hot, pungent, and dry give rise to grief, mental stress, and diseases.

Yatyaman gatarasam, pootiparyushitachya yat

Uchhistamapi chamedhyam, bhojanam tamspriyam [1].

Foods that are cold, prickled, putrefied, and preserved are lured to criminals and give rise to criminal tendency and behavior.

The role of mind in the pathogenesis of emotional stress has also been emphasized in Bhagavad Gita: In Sanskrit:

Chanchalam he mana: Krishna pramathi valvad draham

tasyam nigraham voyoruh: sudushkaram. The mind is very unsteady, tenacious, turbulent, and difficult to curve like wind, but it can be controlled by the practice of meditation and feeling of dispassion.

The chanting of Oem and Panchamrit (five nectars) is considered good for health due to their contents; cow milk and curd, basil leaves, honey, and raisins. It is distributed to audience for health and longevity after worshiping God or after Havana in Hinduism [1,4] (Fig. 1.3).

Figure 1.3 Exploring role of Panchamrat (five nectars); cow milk, curd, basil leaves, honey, and raisins, the Ancient probiotic from India. Adapted from reference Deussen P, The philosophy of the Upanishads. Motilal Banarsidass (2011 Edition), ISBN 978-8120816206, 23 p; The Atharvaveda. Forgotten Books Paperback ISBN-13: 978-1605065854, Forgotten Books, 1 January 2008.

The worship of trees and animals

The worship of trees and animals are important part of lifestyle as well as health and are common in the Sanatana religion (Hindu), Jainism (Jain), and Buddhism (Buddhist), all concerned with a prolongation of a healthy life. In all Indian religions, the message was/is do not harm others, even plants and animals. This teaching lead Indians to worship trees such as Banyan, Ficus benghalensis (Bergad), Ficus religiosa (Peepal), Azadirachta indica (Neem), basil, and also animals such as cow, mouse, elephant, and lion who are connected with Indian deities. The trees are also known to have medicinal value today. India is the first country in the world, where animals, plants (Basil), and trees are worshiped, from ancient period until today, possibly to preserve a balance with the nature, which is most recent concept in the Western world (UNO, FAO, WHO). The practice of such concepts gives optimism with positive emotions and attitudes, not to harm others. There is evidence that yoga, optimism, prayer, and transcendental meditation, a life style approach combined with dietary adaptations, are now understood to be good for a general well-being. Furthermore, Asanas (Yoga postures) or specific corporal postures mostly adopted from Hathayoga, a gift from ancient India, have a role even in the prevention of cardiovascular diseases (CVDs) and other chronic diseases.

The ancient masters of medicine

Hippocrates and Galen (Greece), Sushruta (India), Charaka (India), Bhela (India), Amenhotep (Egypt), and Confucious (China), the Chinese Philosopher, are considered ancient experts of Medicine and Health [5–10]. Hippocrates (5th century BCE), called the father of Modern Medicine, proposed that "lets food be our medicine" [10]. Hippocrates used to give frequently, dietary advice to the patients during treatment. Since the days of ancient Greece, doctors in all countries used to provide dietary advice to their patients in the treatment, indicating that they had similar concepts in relation to diets and health [2–7]. Since dietary concepts in relation to diseases were similar in India and Greece, it is possible that both countries had exchange of knowledge during ancient periods around 600 BCE.

All writers on the origin of Medicine have described in great details about the achievements of Modern Medicine by Hippocrates; hence, this chapter would focus more on others, in particular about India, to introduce these ancient experts to Western world [2–4,10–14] (Fig. 1.4).

Figure 1.4 Hippocrates (460–370 Before Common Era, BCE) of Cos. He was considered, the father of scientific medicine, and the first physician to provide a written exercise prescription for a patient with the disease of consumption. Adapted image from Singer Haynes DH. Mechanism of Ca2+ transport by Ca2+-Mg2+-ATPase pump: analysis of major states and pathways Am J Physiol 1983;244(1):G3–G12. https://doi.org/10.1152/ajpgi.1983.244.1.G3.

Taxila University a Center of Excellence in Ancient India (600 BCE–CE 500)

University of Taxila or Takshashila, an ancient university in Ancient India (now Pakistan), flourished between 600 BCE and CE 500, in the kingdom of ancient Gandhar (Kandhar in Afghanistan). There were 68 subjects that were taught including Vedas, Grammer, Philosophy, Astronomy, Medicine, Surgery, Politics, Archery warfare, Military, Music, Commerce, Economics, etc. [2]. It has been proposed based on the various documents obtained via excavations, in the museums, that Taxila university in ancient India may have been the meeting point for all the world experts of Medicine from 600 BCE till it was destroyed by Hun in CE 500, where Ayurvedic Medicine and Surgery were major subjects of teaching and learning [2,3].

Taxila university served students and scholars from all the countries of the world including Greece, Egypt, China, Rome, Persia, Syria, etc. It was a center of excellence for a study of Ayurveda that included Medicine and Surgery. Charaka, Sushruta, and Bhela were possibly students in this university and Charaka was also a Professor of Ayurveda. It has been proposed that Hippocrates and Galen must have visited this University, at least as experts of Medicine, for exchange of knowledge, because the knowledge collected in the concerned treatises is very much similar to that described in Charaka Samhita and Sushruta Samhita [2,3,6,7,10–13,16].

Medicine in Egypt

The Egyptians knew of a number of components of heart failure, such as cardiac hypertrophy [5]. In Egyptian Medicine, the earliest known writings on the circulatory system are found in the Ebers Papyrus (2000–1600 BCE), an ancient Egyptian medical papyrus containing over 700 remedies and prescriptions, both physical and spiritual [5]. In the papyrus, it acknowledges the connection of the heart to the arteries. The Egyptians thought air came in through the mouth and into the lungs and heart. From the heart, the air traveled to every chamber through the arteries. Although this concept of the circulatory system is only partially correct, it represents one of the earliest accounts of scientific thought [5]. Amenhotep (Asyut) (2000 BCE), an engineer and a chemist, also had good knowledge of heart pain (Angina). He proposed that if pain in the center of the chest is associated with abnormal pulse, it shortens the life.

The ancient Egyptian word for doctor is swnw, which has a long history. The earliest recorded physician in the world, Hesy-Ra, practiced in ancient Egypt [5]. He was Chief of Dentists and Physicians to King Djoser, who ruled in the 27th century BC. The lady Peseshet (2400 BC) may be the first recorded female doctor: she was possibly the mother of Akhethotep, and on a stela dedicated to her in his tomb; she is referred to as imy-r swnwt, which has been translated as Lady Overseer of the Lady Physicians [5]. Other important experts in Medicine in ancient Egypt were as follows: Hearst papyrus (2000 BCE), Carlsberg papyrus (2000 BCE), Kahun Gynaecological Papyrus (1800 BCE), Ramesseum medical papyri (1800 BCE), Erman Papyrus (1600 BCE), Ebers Papyrus (1500 BCE), and Leiden Papyrus (1343 BCE) (Fig. 1.5).

Figure 1.5 Imhotep (1500–2000 BCE) and Amenhotep (Son of hapu). Most skilled Physician of Egypt in the third of the Eighteen Dynasty (2000–1500 BCE). Adapted from Wikipedia.

Medicine in China

Dietary advice was also given in China for health. Confucius, the Chinese philosopher, taught his students, "The higher the quality of foods, the better and never rely upon the delicacy of cooking. Thus, a dietary guideline by Confucius, based on experience, observation, and thinking, was given as; cereals, the basic, fruits the subsidiary, meat the beneficial and vegetable the supplementary." Meat may have been considered beneficial because it was obtained by hunting of running animals, which is characterized with fatty acid content that have been found to be healthy [2,3].

In China, the Yellow Emperor’s Classic of Internal Medicine discussed dropsical swellings as early as 2600 BC [12]. Shennong, is considered, the founder of Chinese medicine. He was also known as the Divine Husbandman. Huangdi, the famed Yellow Emperor who ruled in the 27th century BCE. He was at one time believed to have written the Huangdi Neijing (The Yellow Emperor’s Inner Classic) [2,16]. In the 7th century BC, a Chinese physician proposed that increased consumption of salt may cause hardening of the pulse [5,9] (Fig. 1.6).

Figure 1.6 Shamanism in Chinese Medicine, The association with the supernatural. Adapted from, https://wsimag.com/wellness/44155-shamanism-in-chinese-medicine.

Ayurveda and the hidden knowledge of medicine and its philosophy in India

Many ancient and modern experts have enlightened from Ayurveda and Indian system of Medicine [1,6–9,11]. While Rig Veda and Athar Veda (5000 BCE) are considered as origin of Indian system of Medicine called Ayurveda, Sushruta Samhita and Charaka Samhita are Treatise written by concerned experts [1,4,6,7]. Heart pain is born by the fatty meals and sedentary behavior and all diseases begin in the gut and mind were proposed by Charaka and Sushruta in 600 BCE and are similar to the views expressed by Hippocrates in 460 BCE (Figs. 1.7 and 1.8).

Figure 1.7 Charaka and Sushruta (600 BCE) whose description of diet and health were similar to Hippocrates. Adapted from Google.

Figure 1.8 Susruta is depicted performing an otoplastic operation. The patient, drugged with Drakchhasav (wine), is steadied by friends and relatives as the great surgeon sets about fashioning an artificial ear. Adapted from references Samhita S. Chaukhamba, Varanasi, India 2018, ISBN-10: 9386660865; Tipton CM. Susruta of India, an unrecognized contributor to the history of exercise physiology. J Appl Physiol 2008;01 Jun 2008; https://doi.org/10.1152/japplphysiol.00925.2007.

The Susruta Samhita provided important surgical and anatomical information of the understanding of anatomy by Indians in the 6th century BCE [6]. Ayurveda is defined as a combination of two components in Sanskrit: Ayu meaning life or age or longevity and Veda meaning knowledge, which came into practice possibly from 5000 BCE. Ayurveda is defined as knowledge for healthy life including physical, mental, social, spiritual, and possibly intellectual well-being. Spiritual and intellectual aspects of life were given major consideration in ancient systems of lifestyle and health [6,7]. The Modern system of Medicine and the World Health Organization (WHO) have only recently adopted the same ethos for the definition of health.

Fasting weekly on Tuesday, eating once in a day (low caloric diet) and before sunset to prevent entering of small insects in the mouth with food (Jainism) are still common practices in India, as characteristics of religion. Fasting on Ekadashi which is a Sanskrit word for the number 11. Ekadashi stands for the 11th day of each half of the month in the lunar calendar and there are two Ekadashi days in each month. One Ekadashi day is in the first half of the month when the moon is waxing, and the second is when the moon is waning resulting into the alterations in moon activity and its gravitational force. Currently, it is becoming known that it may have a Chronobiological significance for health, because of the gravitational force imposed by the moon. Varying distances of the moon from the earth can influence biological functions on the life on earth. Although it is now laid down by Halberg in 1950s, but the concept of influences of moon on living beings on earth has been there for millennia. It seems that the practice of fasting on this day has been connected with religion for the sole purpose of health and well-being. It is because of religion that common people followed such dictum of fasting for the last 7000 years from now in India. Dr Yoshinori Ohsumi working on autophagy was awarded the Nobel Prize for medicine in the year 2018. Autophagy controls important physiological functions, where cellular components need to be degraded and recycled. Autophagy means to self eat and is the pathway by which the cell eats its own damaged cells and unused proteins, as mechanism of adaptation. Autophagy is cytoprotective and prosurvival process, which may be more effectively occurring during fasting. After an infection, autophagy can eliminate those cells infected by invading intracellular bacteria and viruses. In Ayurveda, there is a saying, Starve a cold, which indicates that the ancient experts may have observed these correlations across a physical, emotional, and mental spectrum. Activation of autophagy by any means such as fasting may help to eliminate the damaged cytoplasmic components, thereby regulating the stress signaling and extending cellular function and survival.

Charaka was a Acharya (Professor) physician (Vaidya) at Taxila University (600 BCE), where Ayurveda (Medicine), Music, and Religion were major subjects of study [6,7]. Charaka is believed to be the first in the world to diagnose diabetes mellitus as Madhumeh in Sanskrit by tasting the sweet taste of urine [7]. Charaka possibly in the same era scripted the drug therapy of various diseases in Charaka Samhita having 120 chapters with definite effort to move treatments to a reason-based approach.

Sushruta was a surgeon, scientifically depicted the various aspects of human biology, anatomy, and surgery with instrumentations in a book called Sushruta Samhita, a great classic on the science of surgery which earned him the title of father of surgery internationally. He was a surgeon at Varanasi (India), (in an ancient university), considered to be the oldest city of the world and descendent of Vishwamitra, the great sage, who created alternate path to go to heaven. Sushruta, primarily a surgeon, gave a more lucid description of atherosclerosis, which would be described later in this chapter [6].

Gautam Budha proposed eightfold path to achieve total health and for universal peace and happiness (480 BCE). The meditation, mindfulness, concentration, and occupation have been proven to protect from diseases and are instruments of health promotion. Buddha advised in Sanskrit "Satyam Brooyat, Apriyam Satyam nah brooyat" (speak truth but do not speak truth, that is unpleasant to others). The world should try to understand Buddha, to modulate so called Freedom of Expression, which is a human right. Freedom of Expression, a Human Right means, live like a human, think like a human, believe like a human, and express like a human being. It does not mean to injure the belief of others, because our expression may injure our health, in particular heart and brain health (Ram B Singh) (Fig. 1.9).

Figure 1.9 Buddha and The EightFold Path (480 BCE). Adapted from Google search.

Ancient knowledge on cardiovascular diseases

The Ayurveda is considered to be derived from Atharvada (5000 BCE) [4]. However, the documentation and description of the health and diseases and functions of the heart in India dates back to 600 BC in Charaka Samhita and Sushruta Samhita who were able to diagnose various diseases by examination of the pulse (Nadi) at the same place on the wrist, as today [6,7]. Indians may have been the first to declare that most of the diseases begin in the mind and may be due to Vayu (wind) in the abdomen and pitta (Bile). In Ayurveda, brain patterns of man are associated with the three categories of regulatory principles of the body, mind, and behavior, called Vata (Wind, gas), Pitta (Bile), and Kaphah (Phelgm) tri-dosha (Three Defects) doctrine, which can be assessed by the examination of the pulse. Defects in Pitta and Vata may have impact on the functioning of the immune, digestive, cardiovascular, and virtually all other systems of the body [6,7]. In the tri-dosa doctrine (humoral theory), the stated disease was a resultant, when one or more of the three bodily humors (dosas) became displaced and that health occurred when they were in equilibrium