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In the human body there are 3 different types of muscle – smooth, skeletal and cardiac muscle.

muscle-cellsCardiac muscle is unique in many ways including its shape. Myocardial cells are corrugated, and somewhat star-shaped, which allows contact with a greater number of neighboring cells and to a greater extent, which is advantageous in conductivity.

The heart is a pump, which beats nearly 1 million times per week, and over 3 billion times in an average lifespan.  This impressive capacity, however, must not be taken lightly, and some attention should be paid to maintenance of good cardiovascular health.

The heart is a relatively hollow, muscular, electrochemical organ which pumps blood to the body, lungs and to itself. It is composed of 4 chambers and 5 valves.


Figure 1 – IVC drains into right Atrium past Eustacean Valve


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The right side of the heart pumps de-oxygenated blood to the lungs via the pulmonary arteries, where its CO2 content is released into the lungs and O2 is taken into the blood. The oxygen-rich blood then returns to the left side of the heart, which pumps that blood to the entire body. The O2 is released into the issues of the body, and waste products of metabolism, including CO2 are taken by the blood back to the right side of the heart.  

 heartThe cardiac ventricles are responsible for the strong contractions which allow blood to reach the brain, against gravity, and to reach the toes, even in individuals over 7’ tall.  The atria fill up during the time when the ventricle are contacting, in order that circulation can continue, uninterrupted.

The function of the 4 main valves is to ensure that flow within the heart is in one direction. The eustacean valve (fifth valve) prevents flow, which enters the right atrium from the IVC (main vein) below, from returning to the IVC under pressure of gravity.

 In the heart, there are specialized conductive myocardial cells which are autorhythmic. Autorhythmic cells are self-stimulating and contract without any external stimulation. In other words, these cells are leaky, eventually allowing positively charged ions to enter, until the charge inside the cell is positive compared to the outside of the cell. Once the charge inside reaches a threshold level, the cell contracts.

However, in a pump, there must be some organized approach to contraction, in order to maximize the pumping function. If all conductive cells contract at the same time, no effective ejection of blood will result. So which cell contracts first?heart2.gif

Figure 2 – Specialized electrical conductive pathway

A group of cells in the right atrium, called the Sinoatrial Node, represent the most leaky cells in the heart. So they reach their charge threshold faster than any other cells in the heart, and therefore, this spot contracts first. This is why the SA node is also call the pacemaker. The cardiac impulse originates in the SA node, located in the right atrium and activates first the right atrium then the left atrium. The general direction of the atrial activation is inferiorly, to the left, and posteriorly. This causes the atria to contract and pump blood from the atria to the ventricles.  On an EKG, the contraction of the atria is recorded as a P wave.

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Fig. 4 – a. Normal EKG,  b. ST segment elevation, often seen in infarcts,  c. ST depression associated with ischemia.


The atrial impulse is delayed in the atrioventricular node (AV node) to allow the ventricular chambers to fill, and is then conducted rapidly through the ventricles (the bundle of His, the right and left bundles, the Purkinje fibers and finally through the myocardium). This causes the ventricles to pump blood out of the heart and to the body; it is recorded on an EKG as a QRS complex.

Recovery following the cardiac cycle, or repolarization, follows. This is recorded as a T wave. In the presence of ischemia (decreased O2 supply or hypoxia) or injury to the heart muscle, the repolarization becomes irregular, so the T wave inverts or increases in size.

 There are many disease associated with the heart:

  1. Coronary Heart Disease
  2. Cor Pulmonale
  3. Congenital Heart Defect
  4. Cardiomyopathy
  5. Myocardial Infarction
  6. Congestive Heart Failure
  7. Valvular Heart Disease
  8. Arrhythmia
  9. Peripheral Arterial Disease
  10. Cerebrovascular Accident
  11. Rheumatic Heart Disease


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Coronary Heart Disease

Coronary Heart Disease (CHD), also referred to as Coronary Artery Disease (CAD), has been a leading cause of death for years now, not only in the United States, but all over the world. In this condition, the arteries that supply blood (blood rich in oxygen and nutrients) to the heart, harden or thicken due to the deposition of plaque along their walls. Plaque is made up of fat and cholesterol. The deposition of plaque along the arterial walls is a gradual process. This hardening of the arteries narrows the passage through which blood flows, thus preventing free flow of oxygen-rich blood to the heart.

Causes include dyslipidemia, diabetes, smoking (increased blood levels of carbon monoxide and nicotine), significant hypertension, obesity, high stress levels, inactivity, and unhealthy diet.

Cor Pulmonale

Cor Pulmonale, or pulmonary heart disease, is a disease in which the right ventricle of the heart enlarges due to increase in blood pressure in the pulmonary arteries. Pulmonary arteries are vessels that carry blood from the heart to the lungs. The high pressure in the arteries puts extra strain on the heart and can eventually lead to failure of the right side of the heart.

Causes include lung emboli, pulmonary hypertension, obstructive sleep apnea, COPD and cystic fibrosis.

Congenital Heart Defect

A congenital heart defect (CHD) is a condition in which there is an abnormality in the structure of the heart, which is present at birth. This is the most common birth defect in which the heart and the blood vessels of the baby are not completely formed.

Causes include inheriting defect from a parent, association with other congenital diseases such as Down Syndrome (trisomy 21), mothers who during gestation, are obese, alcoholic, diabetic, suffer from flu or rubella or are exposed to toxic substances (e.g. paint, glue).


In this condition, it becomes extremely difficult for the heart to pump blood to the other parts of the body. People from any age group may be affected with this condition and that is what makes it dangerous. Cardiomyopathy can lead to arrhythmia (irregular heartbeat) and heart failure. There are three main types of cardiomyopathy:

Dilated Cardiomyopathy – the ventricles and atria of the heart grow in size (dilate). Due to this the heart cannot pump enough blood to the body.

Hypertrophic Cardiomyopathy – disproportionate thickening of the heart muscle occurs. The chambers which carry blood become much smaller and may not be able to cope with incoming volumes of blood.

Restrictive Cardiomyopathy – the walls of the ventricles harden and stiffen till they become rigid.

Causes include alcohol and drug abuse, hypertension, rapid heart rate and hemochromatosis (iron buildup in the body), diabetes, thyroid dysfunction, hereditary.

 Myocardial Infarction

Myocardial infarction or acute myocardial infarction, commonly known as a heart attack, is one of the most common medical emergency conditions, which comes with a high mortality rate.

Causes include partial or complete blockage of one or more of the coronary arteries, atherosclerosis, hypertension, elevated cholesterol, smoking, increased stress levels, inactivity, excessive use of certain drugs, family history, unstable angina, and hypoglycemia.


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Congestive Heart Failure

Congestive heart failure or heart failure is one of the most common conditions affecting the heart. It is the failure of the heart to meet the body’s demands of adequate blood circulation. The different types of congestive heart failure are acute or chronic heart failure, high-output or low-output heart failure, and left-sided or right-sided biventricular failure. There can also be compensated or decompensated heart failure.

Causes include decreased myocardial contractile force (from viral pneumonia, rheumatic fever, beri beri, coronary heart disease, hypertension, diphtheria, amyloidosis, and degenerative diseases involving the heart), volume overload of the heart (as seen with valvular disease), diseases interfering with diastolic filling of the heart (constrictive pericarditis, pericardial effusion, restrictive cardiomyopathy and infiltrative myocardial disease such as amyloidosis/ sarcoidosis), rhythm disturbances of the heart (includes atrial tachycardia, flutter and fibrillation, as well as heart block), conditions where there is increased pressure on the heart to pump out more (e.g. high fever, pregnancy or thyrotoxicosis), and other risk factors including excessive drugs and alcohol consumption, thyroid dysfunction, excessive use of medication, and fatty diets.

 Valvular Heart Disease

The heart has four valves: the aortic and mitral valves in the left part of the heart and the pulmonary and tricuspid valves in the right part of the heart. A valvular heart disease is one which affects any of these four valves. Valvular heart diseases are characterized either by hardening of the valves (valvular stenosis), or regurgitation (valvular regurgitation). Regurgitation happens when blood flows ‘back’ through the valve in the wrong or opposite direction. This condition can be present at birth or acquired later in life due to other underlying cardiovascular diseases.

Causes include congenital valve disease (malformations or incorrect size), bicuspid aortic valve, mitral valve prolapse, conditions of rheumatic fever and endocarditis, connective tissue diseases, cardiomyopathy, heart attacks, certain drugs and radiation.


Any kind of irregularity in the heartbeat is known as cardiac arrhythmia. Heart rate is controlled by a number of factors. These include the sympathetic and parasympathetic impulses. Cardiac arrhythmia can be benign or even be life-threatening. They can manifest as rapid or irregular heartbeats such as premature beats or as ventricular tachycardia or fibrillation. Many a time, cardiac arrhythmia may be the first manifestation of an underlying cardiac ailment.

Causes include anxiety and stress, excess caffeine or tobacco, certain metabolic factors such as diabetic ketoacidosis, hypoglycemia or hypercalcemia, endocrine disorders such as hyperthyroidism, hypothyroidism, pheochromocytoma or hyperaldosteronism, electrolyte imbalances such as hypokalemia, hyperkalemia, altered magnesium levels or hypernatremia, drug toxicity such as with digitalis, diuretics, antidepressants or phenothiazine, and other heart issues such as ischemic, valvular or congenital heart disease.


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Peripheral Arterial Disease

This is a disease in which the flow of blood from the heart to the lower extremities or the legs is restricted or reduced. This happens due to the hardening or thickening of the arteries (atherosclerosis) that are responsible for carrying blood from the heart to the body. Patients suffering from Peripheral Arterial Disease (PAD) or Peripheral Vascular Disease (PVD) experience agonizing pain in the lower extremities like the hip, buttocks, thighs, knee joints, calves, and feet.

Causes include atherosclerosis, inflammation or injury to the blood vessels, increased radiation exposure, obesity, smoking, diabetes, hypertension, and gender (men are at higher risk).

Cerebrovascular Accident

Also known as a stroke, this happens when the supply of oxygen and blood to the brain is hampered, which causes the brain cells to die. In this case, the arteries that carry blood to the brain from the heart rupture (hemorrhagic CVA), or get blocked due to atherosclerosis (ischemic CVA). Cerebrovascular accidents are one of the leading causes of death not only in the United States but also in other parts of the world.

Causes include embolism, diabetes, hypertension, smoking, stress, anxiety, elevated cholesterol, medical conditions such as myocardial infarction, migraines, brain aneurysms, atrial fibrillation, silent strokes or TIAs, deep vein thrombosis, and family history of stroke.

Rheumatic Heart Disease

It is a severe complication that occurs due to rheumatic fever. Rheumatic fever is an inflammatory disease that affects the connective tissues of the skin, joints, muscles, brain, and the heart, and generally affects small children. It generally develops with a throat infection caused by the bacteria Streptococcus. Repeated or prolonged attacks of rheumatic fever can lead to rheumatic heart disease, and damage the valves of the heart to a great extent.

Causes include rheumatic fever (a Streptococcal bacterial infection), untreated or repeated strep throat infections, unhygienic living conditions or lack of medical treatment.

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