Hyperbaric Oxygen Therapy & Cardiovascular Disease

Hyperbaric Oxygen has been studied in Cardiology.

Background: 

The cardiovascular system initially responds to Hyperbaric Oxygen with vasoconstriction, reduced heart rate and cardiac output (baroreflex-mediated mechanism). However, the raised pO2 more than compensates for the reduction of the blood flow. Vasoconstriction is viewed as a regulatory mechanism to protect the healthy organs from exposure to excessive oxygen. Usually the vasoconstrictor response does not take place in the hypoxic tissues.

Hyperbaric Treatment improves the elasticity of the red blood cells and reduces platelet aggregation

Hyperoxia causes an increase in nitric oxide (NO) synthesis.

 
Recent cardiac surgery, congestive heart faliure, amiodarone, insulin, digitalis, losartan, reserpine, guanethidine and heparin possibly interact with Hyperbaric therapy. The dosages of insulin required in diabetes are decreased during HBO therapy and should be readjusted

Vitamin E. Vitamin E is believed to protect against oxygen toxicity by counteracting the oxygen free radicals . A dose of 400 mg daily should be given to patients scheduled for Hyperbaric Therapy starting 2 days before the therapy

Magnesium's antioxidant and vasodilating effects can also reduce oxygen toxicity. A single dose of 10 mmol (2.5g) of magnesium sulfate can be given 3 h before a HBO session.

Ulcers

Although, UHMS official indication 6b) is "Arterial Inefficiencies: Enhancement of Healing In Selected Problem Wounds" venous and arterial ulcers don't appear to be official UHMS recommendations. "Although the underlying physiology and basic science support the contention that HBO2T is likely to be useful in a variety of problem wounds, the best evidence exists for treatment of ischemic, infected (Wagner Grade III or worse) diabetic foot ulcers." So UHMS is suggesting HBOT for diabetic ulcers primarily however evidence exists for other types of ulcers. 

According to Jain 2017, general measures for all leg ulcer patients should include the following:

• Elevation of the leg at night to diminishes the exudate from the ulcer and reduce edema.

• Compression: by special stockings 

• Ulcer dressing and topical treatment.

Arterial Ulcers: In a study of 22 patients with leg ulcers from to chronic arterial insufficiency treated Hyperbaric Oxygen at 2–2.5 ATA for up to 70 sessions, 15 obtained relief of pain and 12 had healing of the arterial ulcers (Kidokoro et al. 1969).

Hyperbaric Therapy at 2.0 ATA was used to treat 16 patients with treatment resistant arteriosclerotic ulcers and in 75 % of cases, the ulcers healed completely (Hart and Strauss 1979).

In another study on 50 geriatric patients with arteriosclerotic ulcers treated with Hyperbaric oxygen alone at pressures between 1.5 and 3.0 ATA showed healing in 52% and improvement in 20 % and amputation was avoided in 65 % of them (Perrins and Barr 1986). 

Additional conclusions made by Perrins and Barr: 

Many patients with resistant vascular disease ulcers can be healed by prolonged courses of Hyperbaric Oxygen.

The response is unpredictable: Some ulcers respond to 1.5 ATA, while others needed up to 3 ATA. Some ulcers fail to respond to even 2 h per day and others heal with less than 1 h a day.

General nutritional sufficiency is key for healing of ulcers which our Naturopaths can achieve with IV Therapy - additional Vitamin C, Zinc and Selenium are key additions our Naturopathic Doctors add to our IV treatments. 

Veinous Ulcers: (also referred to as stasis ulcers): is a manifestation of chronic venous insufficiency. Hyperbaric Therapy promotes healing of venous ulcers but is said to be unnecessary for the healing (according to Jain 2017). 

In one study, Hyperbaric Therapy was used at 2.5 ATA once daily for treatment of 17 patients with varicose ulcers of the legs. Five patients healed completely, six showed marked improvement, and another four had slight improvement (Slack et al. 1966).

In a different study, complete relief was obtained in 17 of 19 resistant cases of venous stasis ulcers by the use of Hyperbaric Treatment at 2 ATA (Bass 1970).

Combination of Hyperbaric Therapy with skin grafting is more effective than Hyperbarics alone. Skin grafting is carried out for large veinous ulcers, and HBO is also used as an adjunct to promote healing of skin grafts.

For veinous insufficiency, Horse chestnut is a favorite of our Naturopathic Doctors. The horse chestnut seed extract preparations used in most clinical trials were standardized to contain 50 mg of aescin per capsule, and were given in dosages of 1 capsule 2–3 times per day. 

Our Naturopaths also often add flavonoids (which are easily found locally in Edmonton) to enhance tissue integrity, including the tissues of the veins and capillaries. Consumption of adequate amounts of flavonoids might therefore help prevent the development or progression of varicose veins and improve symptoms of venous insufficiency by decreasing capillary permeability and, consequently, the amount of fluid that leaks through the capillaries into the extravascular space of the legs.

Angina

Angina: Efuni et al. (1984) found a reduction in the severity of angina pectoris after Hyperbaric Oxygen by looking at 138 coronary patients and 23 normal subjects by isometric test. 

Goliakov et al. (1986) Looked at the effect of Hyperbaric treatment was shown to produce a favorable effect in 84 % of the 40 patients with angina pectoris through reducing platelet aggregation and the serum fibrinogen content.

Smetnev et al. (1979)) treated 77 patients with chronic heart disease patients - 52 of which had angina and 25 had "postinfarction cardiosclerosis" with circulatory insufficiency with 12-15 treatments with Hyperbaric Oxygen, which in combination with pharmacologic intervention, alleviated or arrested the angina and improved the symptoms of cardiac decompensation.

Our Naturopaths have seen impressive results treating angina with IV Magnesium. In case reports and uncontrolled trials, administration of a series of magnesium injections resulted in complete symptom relief or marked improvement in the majority of patients with angina.

CoQ10 is also a clinic favorite as it is a low cost oral addition. In one study, the mean number of angina attacks per week was 42% lower in a CoQ10 supplemented group. Our Naturopaths like CoQ10 because it's an endogenous antioxidant with with impressive multisystem effects and can also help stabilize elevated blood pressure in a cardiovascular context.  

Peripheral Vascular Disease 

Sakakibara (1986) used Hyperbaric Oxygen in 159 patients with chronic peripheral vascular disease seen over a period of 18 years, of which, 69 % had healing of their sores. Furthermore, the incidence of amputation required was decreased in all the patients. 

Visona et al. (1989) treated patients in various stages of peripheral vascular disease and reported clinical symptoms improved in 70% with long-term improvement in more than 50 % of the cases.

Our Naturopathic doctors usually defer to adding IV Phospholipids in Peripheral Vascular Disease as human data exists for Plaquex improving walking distance in patients with PVD. IV Therapy with Phospholipids is a slow, gentle approach to improving vascular integrity.  

Hyperbaric Oxygen and Cardiovascular Disease

Naturopathic Cardiology:

Ischemia (insufficient blood flow to a particular tissue or organ to meet the needs of that tissue or organ) is usually caused by atherosclerosis and the following discusses some Naturopathic efforts in preventing atherosclerosis. 

Diet:

Monounsaturated fatty acids (i.e. - olive oil) are more resistant to oxidation than are polyunsaturated fatty acids and incorporation of these fatty acids into LDL, renders the LDL more resistant to oxidation. We often encourage liberal use of Olive oil in an uncooked state. 

Consumption of allergenic foods can lead to the production of immune complexes, which can trigger an inflammatory response and possibly promote the development of atherosclerosis. Our Naturopathic Doctors run a ton of food allergy testing in Edmonton and cardiovascular health is one of many improvements to be had.

In addition to olive oil, the Mediterranean diet emphasizes salads, legumes, wheat, fruit, nuts, and garlic.  In a 10-year prospective study conducted in 11 European countries, adherence to a Mediterranean diet was associated with a reduced risk of cardiovascular disease-related mortality and all-cause mortality. Our Naturopathic Doctors often suggest a Mediterranean-esque diet, that is, with less inclusion of wheat and legumes and more emphasis on vegetables. 

Nutrients: 

Magnesium plays a major role in myocardial energy production, inhibits platelet aggregation, promotes vasodilation and prevents vasospasm, and has antiarrhythmic activity. Oral and Intravenous Magnesium are key interventions our Naturopaths use for Cardiovascular disease prevention. IV Magnesium in particular is effective in raising heart magnesium much more effectively than oral supplementation. 

Potassium also has an antihypertensive effect and decreases platelet reactivity and higher potassium intake was associated with a lower incidence of stroke. Our Naturopaths prefer in most cases to increase potassium intake through dietary modification (for example, by eating more fruits and vegetables) rather than by supplementation. 

Omega-3 fatty acids present in fish oil lower triglyceride levels, inhibit platelet aggregation, decrease blood viscosity, lower blood pressure, exert an antiarrhythmic effect and improve endothelial function. 

Vitamin K plays a role in the synthesis of "matrix Gla protein," which is a strong inhibitor of vascular calcification. 

Cardiovascular risk factors:

Homocysteine (a byproduct of methionine metabolism) may contribute to the pathogenesis of a number of chronic disorders, including atherosclerosis, thromboembolism and stroke. Numerous clinical trials have found that lowering homocysteine levels (usually by supplementing with various combinations of folic acid, vitamin B₆, and vitamin B₁₂) is useful for preventing these. Our Naturopaths can easily administer Methyl-B12, Methyl-Folate and B2 and B6 intravenously for homocysteine reduction. 

C-reactive protein (CRP) is an acute-phase protein that is synthesized during the process of inflammation and most studies demonstrate a reduction in CRP with omega 3 supplementation.

With Cholesterol, Niacin is a Naturopath favorite namely because in one study where 969 patients were followed for a mean of 10 months on niacin reduced total cholesterol by 19.1%, LDL-C by 24%, and triglycerides by 32.5%, and increased HDL-C by 5.7%. Niacin is of course a precursor to NAD+ which our Naturopathic Doctors adore for its longevity promoting properties.

Questions?

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