As an active muscle, the heart needs a continuous supply of oxygen. The coronary arteries have the job of carrying oxygen to the heart. These arteries have a difficult job to do because they undergo intense compression every time the heart beats. This job becomes even more difficult when the arteries are damaged by atherosclerosis (commonly, though not quite accurately, called “hardening of the arteries”) in a condition called coronary artery disease.

In coronary artery disease the passages inside the coronary arteries become narrowed by plaque deposits, which decreases blood flow. When the blood flow is decreased to a sufficient extent, pain caused by oxygen deprivation occurs. This pain is known as angina pectoris. Angina tends to wax and wane, generally worsening with exercise.

A heart attack may occur after years of angina, or with no warning at all. Most heart attacks occur when a blood clot (thrombus) forms on the roughened wall of an atherosclerotic coronary artery. Such a blood clot may lead to a sudden and complete blockage of the artery. More rarely, a spasm of a coronary artery may cut off blood flow. In either case, the cells of the heart fed by that artery begin to die. The region of dead cells is called an infarct, leading to the technical name for a heart attack: a myocardial infarction (MI).

The classic symptom of a heart attack is intense, central chest pressure. Other common symptoms include: pain or heaviness in the left arm, nausea, shortness of breath, increased perspiration, and a feeling of impending doom. However, many people who have had an MI describe chest "discomfort," or pain in the jaw, teeth, arm, or abdomen. Women are more likely than men to feel pain in their backs. Often, symptoms come on gradually and are intermittent or vague. A quarter of patients—more often women and people with diabetes—experience no symptoms at all.

When a heart attack occurs, emergency treatment at a hospital can minimize the extent of permanent damage to the heart. “Clot busting” drugs, if given soon enough, can open the coronary arteries, allowing blood to flow again. Other methods of restoring blood flow include procedures known as angioplasty, stenting, and bypass surgery. The aim is to save those heart cells that are in danger of dying but are still hanging on to life. Recovery after a heart attack depends on the extent of heart damage. If only a small portion of the heart has died, or if it is in a relatively less important region, symptoms may be slight. More severe damage can cause the heart to pump improperly, leading to congestive heart failure.

During the first several days following a heart attack, the heart has a tendency to lose its normal rhythm and fall into a dysfunctional pattern of beating that does not properly circulate blood. Treatment aimed to prevent or treat this condition, called an arrhythmia, is conducted in a cardiac intensive care unit.

Long-term treatment to reduce the risk of heart attacks generally involves aspirin to prevent blood clots, as well as treatments to slow, stop, or reverse atherosclerosis. The latter is accomplished through the use of medications that keep cholesterol and blood pressure within normal limits, as well as by increasing exercise and improving other aspects of lifestyle.

Principal Proposed Natural Treatments

The most important contribution natural medicine has to make to heart attacks lies in prevention, not treatment. Because heart attacks are, in almost all cases, caused by atherosclerosis, the natural treatments discussed in the atherosclerosis article are relevant to reducing heart attack risk.

In turn, atherosclerosis is accelerated by high blood pressure and high cholesterol, and possibly by high levels of homocysteine in the blood. Natural treatments used for these conditions may very well be worth considering.

Note: Natural therapies for high blood pressure and high cholesterol are generally less effective than the conventional approaches. If you have one or both of these conditions, and you wish to treat them with natural therapies, first consult with a physician to determine how long it is safe to experiment. If natural therapies have not controlled your condition within that time, it may be the better part of valor to use conventional therapies.

Other Proposed Natural Treatments

Several natural treatments have shown promise for use along with conventional treatment in the period following a heart attack. Note, however, that people who have recently had a heart attack should not use any herbs or supplements except under the supervision of a physician. Furthermore, none of these treatments can substitute for standard care; at most, they might be helpful if used in addition to it.

The supplement coenzyme Q10 (CoQ 10) is thought to improve heart function. In a double-blind trial, 145 people who had recently experienced a heart attack were given either placebo or 120 mg of CoQ 10 daily for 28 days.1 The results showed that participants receiving CoQ 10 experienced significantly fewer heart-related problems, such as episodes of angina pectoris or arrhythmia, or recurrent heart attacks.

CoQ 10 taken in combination with the mineral selenium has also shown promise for people who have survived a heart attack.2

The amino acid L-carnitine has shown potential value during the first few weeks after an MI. A double-blind, placebo-controlled study that followed 101 people for 1 month after a heart attack found that use of L-carnitine, in addition to standard care, reduced the size of the infarct (area of dead heart tissue).5 Other complications of heart attack were reduced, as well. Similar benefits were also seen in a 1-year, controlled study of 160 people who had just experienced a heart attack; however, because this study was not double-blind, its results are not reliable.6 (For information on why double-blind studies are so important, see Why Does This Database Rely on Double-blind Studies?)

In the months following a severe heart attack, the heart often enlarges and loses function. L-carnitine has shown some potential for helping the first of these complications, but not the second. In a 12-month, double-blind, placebo-controlled study of 472 people who had just experienced a heart attack, use of carnitine at a dose of 6 g per day significantly decreased the rate of heart enlargement.3 However, heart function was not improved. A 3-month, double-blind, placebo-controlled study of 60 people who had just undergone a heart attack also failed to find improvements in heart function with L-carnitine.4 (Heart enlargement was not studied.)

Results consistent with those of the studies above were seen in a 6-month, double blind, placebo-controlled study of 2,330 people who had just had a heart attack.16 Carnitine failed to produce significant reductions in mortality or heart failure (serious decline in heart function) over the 6-month period. However, it did find reductions in early death. (Unfortunately, for statistical reasons, the meaningfulness of this last finding is questionable: it was a secondary endpoint rather than a primary one.)

Fish oil contains healthy fats in the omega-3 fatty acid category. Incomplete evidence suggests that fish oil supplements may help prevent heart attacks, as well as prevent sudden death after a heart attack.17, 23,29 This benefit may be due any one of a number of fish oil’s actions, including preventing dangerous heart arrhythmias and reducing heart rate 7,18-20

In one study, 432 people who had suffered a heart attack were given either garlic oil extract or no treatment over a period of 3 years.8 The results showed a significant reduction of second heart attacks and about a 50% reduction in death rate among those taking garlic.

Note: People who take aspirin to prevent heart attacks should not take garlic supplements, as the combination could lead to excessive bleeding. (See the full article on Garlic for more information.)

Because of its purported ability to lower cholesterol, red yeast rice (made by fermenting a type of yeast called Monascus purpureus over rice) had been studied in patients with heart disease. A double-blind study performed in China compared an alcohol extract of red yeast rice (Xuezhikang) against placebo in almost 5,000 people with heart disease.25 Over a 4-year study period, use of the supplement reportedly reduced heart attack rate by about 45% as compared to placebo, and total mortality by about 35%. At least three other studies, all from this same original population of participants, have found similar results in diabetics with heart disease 26 and in patients with previous heart attack,27,28 with surprisingly large reductions in the rates of coronary events (eg, heart attack) and mortality. These levels of reported benefit, however, are so high and so similar as to raise questions about their reliability.

Antioxidant supplements help neutralize free radicals, which are dangerous, naturally occurring chemicals that may accelerate heart cell death following a heart attack (among their many other harmful effects). In a double-blind trial, people who had just experienced a heart attack were given either placebo or a mixture of antioxidants ( vitamin A, vitamin C, vitamin E, and beta-carotene) for 28 days.9 The results indicated that use of antioxidants minimized the extent of heart cell damage.

The mineral magnesium is sometimes suggested for stabilizing the heart after a heart attack, but one study actually found a negative effect.10 In this 1-year, double-blind, placebo-controlled trial of 468 people who had just experienced a heart attack, use of a magnesium supplement at a dose of 360 mg daily failed to prevent heart-related events (defined as heart attack, sudden cardiac death, or need for cardiac bypass), and actually may have increased the risk slightly.

The supplemement arginine has been proposed for aiding recovery from a heart attack. In one double-blind study, arginine did not cause harm, and showed potential modest benefit.21 However, in another study, arginine failed to prove helpful and possibly increased post-heart attack death rate.22

Other herbs and supplements sometimes said to be useful after a heart attack, but that lack reliable substantiation, include the following:

Evidence suggests that a program of intensive lifestyle modification, involving an extremely low-fat diet along with exercise and stress reduction, can actually reverse coronary artery disease in people who have had heart attacks, or are at high risk for it.11-13 It is not clear whether less ascetic approaches can achieve similar effects. However, there is evidence that less intensive low-fat and Mediterranean-style (low-fat plus high fish oil) diets can decrease the risk of recurrent heart attacks and similar cardiac events in previous heart attack sufferers.24

Some alternative medicine physicians recommend use of intravenous infusions of a chemical called ethylenediaminetetraacetic acid (EDTA) in order to clear out the arteries of the heart, a method called chelation therapy. This method is based on an outmoded understanding of atherosclerosis, and it is most likely ineffective.14,15

Herbs and Supplements to Use Only With Caution

Numerous herbs and supplements may interact adversely with drugs used to prevent or treat heart attacks. For more information on these potential risks see the individual drug articles in the Drug Interactions section of this database.