Functional Medicine Lab Testing for Heart Disease

Cardiovascular System: Basics

The cardiovascular system comprises the heart and a network of blood vessels (the circulatory system), which transports blood throughout the body.  Some of the key points about the structure and function of the heart are described below:

• The heart comprises four chambers: two upper chambers called atria (atrium for singular) and two lower chambers called ventricles (Figure 1).
• The left ventricle, located on the left side of the heart, is in charge of pumping blood to the brain and body through the aorta, the body’s largest artery.
• On the right side, the heart pumps blood to the lungs.
• The heart has four valves (Figure 1), which open and close to allow blood to flow in or out.
• The heart is covered by a sac called the pericardium or pericardial sac, which helps keep the heart in place, regulate its movements, and keep it separate from other organs.

Our heart provides oxygen and nutrients to cells and tissues through the circulatory system and disposes of waste. There are two basic types of circulatory processes in the human body:

• Pulmonary circulation involves blood without oxygen, which enters the right side or ventricle of the heart (Pulmonary veins, Figure 1), from where it is sent to the lungs to capture oxygen and eliminate carbon dioxide. Once oxygenated, the blood enters the heart through the pulmonary veins of the left atrium.
• Systemic circulation involves oxygenated blood, which is pumped from the heart to all the tissues of the body. This blood also provides nutrients and carries away waste products.

Figure 1. The basic structure of the Heart

2. Heart Disease: pathophysiology

Pathologies affecting the heart and circulatory system, commonly called heart disease or cardiovascular disease (CVD), include many conditions. CVD commonly involves the accumulation of fat plaques that block the normal flow of blood to the heart or other parts of the body. But heart disease can also include other conditions, such as inherited heart defects, genetic mutations, inflammatory disorders, and more. The main types of heart disease affecting adults are described below.

• Arrhythmias, also known as irregular heartbeats, are conditions in which the rhythm of the heartbeats is abnormal. The heart of someone with arrhythmia may beat too quickly, too slowly, or with an irregular pattern.
  • Pathophysiology – arrhythmias are caused by dysfunctions in the heart’s electrical system, known as the cardiac conduction system. Factors like age, family history, genetics, and lifestyle (smoking, certain illegal drugs and excessive alcohol consumption) can increase the risk of arrhythmias. Also, the use of certain medicines, such as medicines to treat high blood pressure, medicine aimed at mental health disorders, certain antibiotics and cold therapy, may increase the risk of arrhythmias. Finally, certain conditions, like heart and blood vessel diseases, kidney diseases, lung diseases, obesity, sleep apnoea, abnormal levels of thyroid hormone and viral infections, can also increase the risk of arrhythmias.
  • Symptoms—People with arrhythmias may feel slow or irregular heartbeats, pauses between heartbeats, or the heart beating too fast or too slow. In addition, common symptoms associated with arrhythmias include anxiety, chest pain or discomfort, confusion, difficulty breathing or gasping during sleep, dizziness and fainting, tiredness, or weakness.

• Coronary Artery Disease (CAD) occurs when fat plaques build up in the blood vessels that supply blood to the heart, blocking or reducing the flow of blood.
  • Pathophysiology—The central mechanism behind CAD involves the buildup of fat plaques. Plaques are composed of cholesterol, fatty substances, cellular waste products, calcium, and fibrin, all of which accumulate inside the arteries. As a consequence, arteries become narrower over time, reducing or blocking blood passage.
  • Symptoms – Chest pain or discomfort (angina), weakness, light-headedness, nausea (feeling sick to your stomach), cold sweat, pain or discomfort in the arms or shoulder, shortness of breath.

• Cardiomyopathy involves a deformed or malfunctioning heart muscle that does not pump blood normally. Consequently, the body does not get enough blood, which can lead to heart failure.
  • Pathophysiology – There are many different types of cardiomyopathies, each with a different cause. Some examples include:
    • Hypertrophic cardiomyopathy – This is caused by a heart that is larger and thicker than usual, which makes the heart inefficient at pumping blood.
    • Dilated cardiomyopathy occurs when the heart’s ventricles weaken and become more significant than usual. As a consequence, these ventricles cannot pump blood efficiently.
    • Arrhythmogenic cardiomyopathy—This rare condition occurs when fatty or scarred tissue replaces the normal muscle tissue in the heart’s right ventricle, causing arrhythmia. It is more common among teens and young adults.
    • Restrictive cardiomyopathy (RCM) is a rare condition in which the ventricles stiffen, leading to dysfunctional heart function. Multiple types of RCMs exist, and they vary in their pathogenesis, clinical presentation, diagnostic evaluation, treatment, and prognosis. The three most common causes of RCM are amyloidosis, cardiac sarcoidosis, and cardiac hemochromatosis.
    • Takotsubo cardiomyopathy, or broken heart syndrome – this rare condition occurs due to extreme stress, which leads to the heart muscle stop functioning optimally.
  • Symptoms – shortness of breath, tiredness, dizziness and fainting, or chest pain.

• Heart Failure – also known as congestive heart failure; this critical condition occurs when the heart is no longer able to pump enough blood to meet the requirements of the body.
  • Pathophysiology – Heart failure can occur when the heart can’t fill enough or is too weak to pump blood optimally. This condition can develop suddenly (acute heart failure) or over time (chronic heart failure). Most commonly, heart failure is caused by a previous medical condition, such as coronary heart disease, heart inflammation, high blood pressure, cardiomyopathy, or an irregular heartbeat.
  • Symptoms – shortness of breath, feeling tired and confused. Patients with left-sided heart failure may experience trouble breathing, cough, fatigue, general weakness, bluish colour of fingers and lips, sleepiness and trouble concentrating, and inability to sleep lying flat. Patients with right-sided heart failure may experience nausea, abdominal pain, swelling in the ankles, feet, legs, abdomen, and the veins in the neck, weight gain, and recurring need to pee.

• Myocarditis and pericarditis—both conditions involve inflammation. Myocarditis involves inflammation of the heart muscle, whereas pericarditis refers to inflammation of the heart’s outer lining.
  • Pathophysiology – myocarditis and pericarditis can be caused by infections (viral, bacterial, parasites or fungi), exposure to some drugs or chemicals, or a previous condition that drives the inflammation.
  • Symptoms—Common symptoms of myocarditis include chest pain, fatigue, swelling of the legs, ankles, and feet, arrhythmias, shortness of breath, light-headedness, and flu-like symptoms. For pericarditis, the most common symptom is chest pain, which may spread to the left shoulder and neck, may get worse when coughing, and may improve when sitting up.

• Valvular Disease is any condition affecting one or more of the four valves found in the heart. There are three basic types of valvular disease: regurgitation, stenosis, and atresia.
  1. Pathophysiology – causes for valvular disease include genetic/inherited defects, which range from mild problems, such as narrow valves, to critical conditions, such as a heart valve that didn’t form. Valvular diseases can also be acquired over time, and some key risk factors include age, family history, confident lifestyle choices (lack of physical activity, smoking, obesity), specific medical devices, such as defibrillators or pacemakers, and previous health problems, like high blood pressure, diabetes, or autoimmune disorders.
  2. Symptoms – symptoms vary according to the type of valvular disease and the patient’s age. In children, symptoms of valvular disease include:
     • Slow growth or weight gaining
     • Blue skin tone
     • Low levels of oxygen in the blood
     • Pale skin
     • Weak pulse
  3. Among adults, common symptoms include:
     • Breathing problems
     • Chest pain
     • Dizziness
     • Fever
     • Fast heartbeat
     • Heart murmur
     • Swelling around eyes, ankles or abdomen.

3. Functional Medicine Diagnostics of Heart Disease

At AUSCFM, we give patients a comprehensive assessment of all risk factors involved with heart disease. This assessment is based on a battery of clinical tests that aim to accurately measure a patient’s real risk of heart disease.

• Advanced Lipid Panels – this test measures LDL Size, HDL-P, LDL-P, Small LDL-P, Large VLDL-P, HDL Size, LP-IR Score, VLDL Size, and Large HDL-P.
• Inflammatory Markers—This test measures the levels of High-sensitivity C-reactive protein (hs-CRP), which is indicative of the levels of inflammation in the body.
• Markers of Oxidative Stress—This test focuses on levels of oxidised LDL, a marker that, when found at high levels, is associated with a wide range of heart problems, including atherogenesis (plaque formation), coronary artery disease (CAD), acute myocardial infarction, stable and unstable angina, metabolic syndrome, impaired glucose tolerance, insulin resistance, and untreated overt hypothyroidism.
• Lifestyle Panel: This test assesses multiple markers associated with heart health, including a basic lipid profile, C-reactive protein (hs-CRP), HDL Map, and Cholesterol Balance.
• Diabetes Panel – this test will help us assess if a patient has diabetes and includes markers for evaluating glucose metabolisms, such as fasting insulin, fasting glucose, and hemoglobin A1c.
• Omega Panel: This test measures the levels of omega-3 fatty acids. High levels of these fatty acids are associated with a lower risk of cardiovascular problems.
• TMAO—This test measures levels of Trimethylamine N-oxide (TMAO), a by-product of intestinal bacteria formed when we consume animal-based foods. High levels of TMAO are associated with a higher risk of developing atherosclerosis.
• Comprehensive Metabolic Panel (CMP): This test measures levels of electrolytes such as sodium, potassium, and calcium and is particularly important for patients at risk of arrhythmia.
• Thyroid Panel – this test measures eight thyroid hormones and antibodies to assess thyroid function.
• MTHFR—This test assesses for clinically essential variations of the MTHFR gene, which codes for an enzyme responsible for folate metabolism. People with specific MTHFR variants have dysfunctional MTHFR enzymes that do not metabolise folate optimally, which can lead to an increased risk of certain CVDs.
• apoB particles—This test measures the levels of Apolipoprotein B-100, a protein normally associated with lipids linked with increased risk of CVD, such as VLDL, IDL, LDL, and Lp(a) particles. High levels of an apo B test strongly indicate a higher risk of heart and blood vessel disease.
• Calcium score CT scan—This test measures the levels of calcium within the plaques in the coronary artery walls. The result is a score that shows how much calcium is in the coronary arteries, which is an indication of coronary artery disease.

4. Focus on Prevention and Treatment of Heart Disease

For all our patients, we employ a combination of standard medical approaches for treating heart disease, including conventional medicines when required by specific patients with a diagnosed heart disease. However, we also vigorously promote supplements and nutritional and lifestyle approaches that are proven to reduce the risk of heart disease both in preventative and treatment contexts. These include:

• Nutrition—Studies to date suggest that following a Mediterranean diet is best for heart health. This diet includes fresh fruits and vegetables, herbs, beans and legumes, whole grains, and fats from olives, nuts, seeds, and fish, like sardines.
• Infrared Light Therapy—This approach has been shown to improve nitric oxide production and benefit people with high blood pressure and impaired blood flow through major arteries.
• Herbs and Supplements – Studies support the beneficial effects of this herb on heart health.
  • Omega-3 – high fatty acid levels are associated with fewer cardiovascular problems. A recent review, for example, found that among nearly 150,000 patients, the consumption omega-3 led to reduced cardiovascular mortality and improved cardiovascular outcomes.
  • According to recent studies, magnesium–low levels of these micronutrients are associated with heart failure and arrhythmia.
  • Curcumin – studies support a positive effect of curcumin consumption on levels of lipids in the body.
  • Berberine – recent studies suggest this compound can be used to prevent and treat heart disease.
• Lifestyle changes
  • Reduce alcohol – excessive alcohol consumption increases levels of fats in the blood (triglycerides) and promotes arrhythmias and cardiomyopathy.
  • Quit smoking – tobacco smoking is one of the main risk factors associated with the development of heart disease.
  • Increased exercise – optimal physical activity is the cornerstone of heart health and central to the AUSCFM strategy to fight heart disease. Our doctors will provide a patient-specific exercise plan to help improve heart and overall health.
  • Reduce stress – studies have shown that emotional stress is linked to an increased risk of heart disease.

5. AUSCFM and Heart Disease

At AUSCFM, our ultimate goal is to resolve the underlying pathologies driving symptoms to restore patients to optimal health. Furthermore, our comprehensive approach to heart health aims to assess the health of your heart before symptoms appear.

Patients will be treated by functional medicine doctors who have ample experience using a holistic and multidisciplinary approach to health care. Based on our comprehensive diagnostic approach, our functional medicine doctors will create a patient-centred treatment plan that tackles the source of heart disease from the inside out.