Author: Juhi Prasad
The heart is a fist size muscle in our chest cavity that is responsible for the flow of blood (and hence nutrients and oxygen) to every single cell and organ in our body. The heart beats without stopping, every minute of our lives, up until the time we die. Thus, any malfunctioning of this organ can have an outcome which is potentially life-threatening. It is estimated that heart disease is one of the most deadly killers in the developed world.
Heart disease forms a whole spectrum of many stages and degrees of severity, with various causes – i.e. the blood supply to the heart could reduce or totally stop, the valves in the heart could malfunction, the muscles of the heart could thicken or increase in size, or the electrical conduction system of the heart could function erratically. These factors could lead to one or several symptoms in the patient, such as breathlessness, edema or puffy swelling especially in legs and lower extremities, oliguria (very little urination at night, often followed by excessive urination during the day), palpitations, chest pains, and dry cough.
This paper focuses solely on heart disease caused due to reduced supply of blood to the heart, or Ischemic Heart Disease (IHD). Ischemia means degeneration due to lack of oxygen, and IHD refers to starvation of coronary muscles of oxygen. When the heart muscle is deprived of oxygen, it begins to die rapidly, giving rise to severe pain. The first part of this paper will briefly outline the main factors causing IHD and currently available medical treatments, while the second part will explain the role of yoga therapy in preventing, stopping the progress of, or even reversing this disease in patients.
Factors that reduce blood flow to the heart:
1. Coronary Artery Blockages:
The heart pumps blood to feed itself through what are called coronary arteries. Oxygen is food for the heart, and is carried in the blood. Three major arteries feed the heart – one on the right side of the heart, and two on the left side. These major coronary arteries branch into smaller ones further downstream.
Blockages (called plaque or artherosclerosis), often made up of cholesterol and other deposits, can be formed in the arteries, leading to reduced blood flow to the heart, causing chest pains (angina) and even heart attacks (myocardial infarction).
These blockages form when the lining of a coronary artery is damaged. The body attempts to put the physiological equivalent of a band-aid over it, in the form of cholesterol, collagen and other materials. Over time, these materials begin to build up and form coronary artery blockages. The injuries to the lining of the coronary arteries result from high blood cholesterol levels, excessive dietary cholesterol and saturated fat, high blood pressure, and nicotine.
2. Other factors that cause the heart to become starved for blood:
Coronary artery spasm– constriction of the muscles of the coronary arteries
Blood clots – small blood clots can form and lodge inside a coronary artery, thereby obstructing blood flow to the heart.
In most people, these mechanisms work in combination. That is, if a coronary artery is already 70% blocked with plaque, then even a small blood clot can lodge in the artery and reduce blood flow to the heart (causing chest pains or angina), or block it completely (leading to a heart attack). Likewise, the more blocked an artery is, the less coronary artery spasm is required to reduce or shut down the blood flow to the heart.
But let us go further back in the chain of causes to see what activates the mechanism that cause coronary blockages, blood clots, and spasm. The answer lies in the lifestyle choices we make every day – i.e. what we eat, how we respond to stress, how much we exercise, whether or not we use/abuse tobacco, alcohol and other drugs can all lead to heart disease.
• Diet – a diet rich in saturated fat and cholesterol provides the building blocks for coronary artherosclerosis. Such a diet affects the heart very quickly, not just over a period of years. Even a single meal high in fat and cholesterol may cause the body to release a hormone, thromboxane, which causes the arteries to constrict and blood to clot faster – one reason why heart patients often get chest pain after eating a fatty meal.
• Smoking – nicotine and other toxic substances in tobacco are absorbed into the blood and injure the lining of the coronary arteries. In addition, nicotine causes the arteries to constrict and causes blood to clot faster and loge in the coronary arteries. Hence, it is estimated that smoking causes more deaths from heart disease than from lung cancer.
• Emotional stress – both acute and chronic. High levels of stress hormones such as adrenaline and nor- adrenaline in the blood can cause coronary artery spasm and increased blood clotting, while excessive levels of cortisol (a stress related steroid produced in our bodies) cause blockages to build up more rapidly in the arteries. Further, research has found that artherosclerotic arteries are hyper-responsive to stress. So the same amount of stress hormones cause partially blocked arteries to constrict even more. The more blocked with plaque an artery is, the more likely the artery will go into spasm at the site of the blockage. Studies done by Dr. Jay Kaplan and his colleagues at the Bowan Gray School of Medicine on monkeys has shown that stress caused formation of coronary artery blockages even when fed a diet lower in fat & cholesterol. When the diet was higher in fat and cholesterol, the influence of stress on causing arterial blockages was magnified 30 times!
Current Medical Treatments:
1. Drugs: Cholesterol lowering drugs are considered to be effective in slowing, stopping or reversing the progression of heart disease. However, even though they are effective in doing so, they have several known and unknown side effects that may cause non-cardiac related deaths. Other drugs commonly taken by heart patients include blood thinners such as aspirin, and beta blockers (for lowering high blood pressure).
2. Surgeries: In the past 60 years, surgeons have invented procedures to improve blood flow around the blockages – 1961, the first coronary artery bypass operation was performed, where a vein was removed from the patient’s leg and spliced around the coronary artery blockages. In 1977, balloon angioplasty was invented – a less invasive approach which required placing a balloon in the blocked arteries to widen them and thus improve blood flow. The balloon has now been replaced with a metal spring called a stent. In 1967, Dr. Christian Barnard performed the first heart transplant.
However, none of the treatments – drugs, bypass surgeries, angioplasty, heart transplants addresses the fundamental cause of heart disease (especially the lifestyle factors), so they all trade one set of problems for another, and the patient runs the risk of the disease worsening or recurring. While it is now commonly accepted that diet plays an important role in the prevention and cure of heart disease, until recently, it was rare to see a research study on stress and heart disease. Even now, most cardiac rehabilitation programs do not teach patients stress management techniques and doctors do not advise their patients to learn them.
Treatment with Yoga:
“If we limit our treatments only to the physical heart, then the disease tends to come back again and again – or the treatments may be worse than the illness. If we also address the emotional and spiritual dimensions, then the physical heart often begins to heal as well” – Dr Dean Ornish, Program for Reversing Heart Disease
While research on using yoga as a therapy for heart patients is still in its scientific infancy, there is growing evidence to suggest that yogic practices have a positive impact on both prevention and cure of heart disease. Several yogic practices strike at the root causes of the disease by reducing high blood pressure, lowering high cholesterol levels, as well as better managing mental and emotional stress. When performed regularly under expert guidance, and combined with a proper diet, Yogic practices can help reduce blockages, aid in the faster formation of collaterals, increase blood circulation, calm the sympathetic nervous system which is responsible for generating stress hormones, and induce positive thinking (thereby reducing cardiac neurosis).
However, especially in the curative stage of heart disease, Yoga therapy must work in conjunction with medical treatment and all practices must be undertaken only after consultation with the physician.
Yoga Nidra: An advanced relaxation technique which includes breath awareness and visualization to help the healing process. In the field of heart disease, this practice is seen as an effective preventive, curative and palliative in all degrees of heart strain and failure. Relaxation has been shown to lower the heart rate, decrease blood pressure and relieve the working strain upon cardiac muscles. This technique can even be used while the patient is still in the Intensive Care Unit, recovering from a heart attack.
Meditation and Chanting: OMKAR or other mantras create positive vibrations which have a very powerful influence on the body and mind and reduce mental and emotional stress.
Pranayama: Nadi shodhana or anuloma viloma (alternate nostril breathing) when practiced in a ratio of 1:2 of inhalation: exhalation has been termed the “coronary pranayama” by Swami Satyananda due to its restorative and rehabilitative impact on the cardio respiratory system - slowing the heart rate and allowing the heart maximum relaxation. Bharamari pranayama and Ujjayi breathing are both powerful yogic tranquilizers that help alleviate anxiety and stimulate the parasympathetic nervous system.
However, stimulating pranayama such as Bhastrika and Surya Bheda should be avoided. Also, kumbhak (breath retention) and bandhas should be not be performed with any pranayama.
Asanas: gentle asanas performed with awareness (such as pawanmuktasana series, tadagasana, shavasana, bhujangasana, tadasana etc) help realign and rebalance both body and mind. They can be used once the patient starts recovering and form a cardio rehabilitative set of movements which help collateral blood circulation without putting any strain on the heart.
Inverted asanas (such as Shirshasana, Sarvangasana, Vipareet Karani etc) are contraindicated, as are other asanas that increase strain on the heart such as the surya namaskar series.
Diet Control – The diet for a heart patient needs to be strictly controlled. Salt intake should be minimal to reduce blood pressure. Meat and other animal products such as dairy products (other than skimmed milk) must be strictly avoided, as they contain high levels of cholesterol. Oily and fatty food must also be avoided, as should preserved, processed and refined foods. Fresh fruit and vegetables high in fiber should comprise the bulk of the diet.
Other Lifestyle Choices – the patient must take regular walks and completely give up nicotine, alcohol and drugs. The patient must also try and stay in a positive frame of mind and, to the extent possible, avoid conflicts and stressful situations.
Available research on the role of Yoga in Heart Disease:
1. In his pioneering research on the impact of stress management techniques and changes in life style and diet on heart patients in the US in the mid-1980s Dr Dean Ornish studied the impact of his ‘Open your Heart’ program on heart patients in the US. He found that in just one year 82% of the patients who followed the program showed an actual improvement of their coronary artery blockages - from 61.1% down to 55.8%. Four to five years on, this reversal was even more dramatic. Since the amount blood flowing through the arteries is exponentially related to the diameter of the arteries, even a small improvement in the blockages was seen to have a significant improvement in blood flow to the heart.
The ‘Open your Heart’ program advocated by Dr. Ornish was composed of:
• Stress management techniques including one hour each day of yoga practice comprising of yogasanas and surya namaskar, shavasana, pranayama, meditation and yoga nidra.
• Diet – a low fat vegetarian diet with no animal products, no added oils and moderate amounts of sugar, alcohol and salt.
• Moderate exercise – ie half hour each day or walking.
• No smoking
2. In a lecture delivered at the International Congress on Cardiovascular Diseases in Calcutta in 1984, Dr. Swami Shankardevananda Saraswati stated that the Bihar School of Yoga has successfully used a yoga regime comprising pawanmuktasana series 1 (i.e. gentle stretching movements performed slowly with breath awareness), pranayama (mainly anuloma viloma and bhramari) and yoga nidra in several cases of heart disease. Combined with a vegetarian, low fat, low salt diet, it has been found to be an important factor in providing symptomatic relief and improvement in heart patients.
3. More recently, a study done in 2004 at the Yale University School or Medicine, USA by Dr. Satish Sivasankaran, MD, showed that yoga improves heart health in both healthy individuals and heart patients – i.e. it is a preventive and curative measure. Based on a six-week study of 33 patients, of whom 30% had heart disease, the research found that patients with heart disease who practiced an hour and a half of yoga (asanas, pranayama, relaxation and meditation) three times a week had a close to 70% improvement in endothelial functioning ( the way blood vessels contract and expand to aid blood flow). The “healthy patients”( the ones without any heart disease), showed a dramatic improvement in blood pressure, pulse rate and BMI (body-mass index).
APPENDIX: RECOMMENDED PRACTICE FOR HEART PATIENT (~1 - 1½ hrs)
Pawanmuktasana Series 1 (toes, feet, ankles, knees, hips, groin, waist, arms, shoulders, neck): 10 min each or Basic Movements (refer Yoga Sopan): 10 min
Asanas: if necessary, relax between each until breathing is back to normal. While holding pose, relax and focus on the heart.
Vajrasana series: 7 min
Supt Pawanmuktasana: 2 min
Naukasana (Boat pose)30 sec
Ardha Chakrasana: 1 min
Suptudrakarshanasana – lying down spinal twist (bend knees and bring to one side and look towards the other) hold for a few breaths on each side
Makarasana (Crocodile pose): to rest until breathing is back to normal
Bhujangasana (Cobra pose): 1 min
Dhanurasana (Bow pose): 1 min
Sashankasana (Child’s pose): 30 sec
Vajrasana (sitting on heels, hands on knees) take a few deep breaths
Ardha Matsyendrasana (Half Spinal twist – can do easy version with one leg straight in front): 1 min each side
Marjariasana (Cat stretch) stretch 6 times up and down
Tadasana (stand on tip toes, stretching hands above)6 times
Kati Chakrasana 6 times
Virabhadrasana (Warrior pose): 30 sec each side
Trikonasana (Triangle pose): 30 sec each side
Shavasana (corpse pose): 5 min
Pranayama (all without kumbhak):
Anuloma Viloma (alternate nostril breathing): 5-10 min, ratio of 1:2,
Sheetali or Shitkari purak with Bhramari rechak (humming bee sound): 10 min
Ujjaiyi breathing: 5 min
Omkar Chanting: 15-30 min each day. (Patient can also sleep while listening to the chant at night)
Yoga Nidra: 30 min once or 2x daily
Jal Neti: once a week (optional)
Note: Al practices must be performed after consultation with the physician, and while continuing medication.
“The views expressed above are solely those of the author. Yogapoint.com may or may not agree with these statements.”
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