Endurance exercise training can create new collaterals to reduce the impact of blocked arteries

By Stephen Pate – One of the most intriguing aspects of coronary heart disease is that we have a mechanism for natural heart bypass that can save our lives and avoid expensive and complicated heart bypass surgery.

Heart disease and stroke are the leading cause of death in North America and Europe, accounting for almost 40% of all deaths, despite significant advances in medical science.

Cause of Death in the United States 2013, date by Center for Disease Control, chart by NJN Network

Cause of Death in the United States 2013, date by Center for Disease Control, chart by NJN Network

We are all going to die someday and the heart is the most common failure point. However, there is no need to die early if we changed our habits.

The body does more to protect us from death by heart attack than even science. We hold the key to our own survival.

In response to endurance exercise training (such as running, bicycling, swimming, and hiking), blood flow is increased, which leads to a conversion from capillaries into collaterals. This is a very elegant treatment everybody can accomplish. It reduces the chances of the occurrence of angina pectoris, myocardial infarctions, and death.

Beyond the interventional, surgical, and medical treatments against coronary artery disease, this collateral training is a natural and valuable therapy that many patients can apply by themselves, for themselves, if only they are aware of it.

I am alive today because my heart, after a potentially fatal heart attack, responded to medication and healed itself. My heart performed its own natural arterial bypass, without surgery. The self-healing heart is on the way to making me healthy and active again. It feels like a miracle and that’s why I am passing this on to you.

Age and genetics are unavoidable factors of heart disease and a potentially fatal heart attack. There are other causes of heart attack that we can fix ourselves like smoking, weight reduction, stress avoidance and regular exercise. Unfortunately, most of us, myself included, have plenty of bad habits that include all the above avoidable causes.

After my heart attack last year, I did not die.  I was given 3 stints and told I had 2 blocked arteries that would need surgery later. Argh! I did not want surgery because it has complications for a person who uses crutches or wheelchairs and I was afraid of “pump head” or cognitive impairment after bypass surgery.

The first heart attack is usually just a prelude to more trouble. Sure as you’re born, I developed unstable angina, or chest pain, related to my heart. Last week after a persistent angina attack, the ambulance took me back to the heart clinic for another coronary angiogram, dye test. I was nervous like a cat going into the test. What if I was worse? What if I needed more surgery?

What a miracle. My heart had healed itself by developing hundreds of collateral vessels to replace the two blocked arterial branches (See Figure 1).

The pain I was experiencing was not another heart attack. It was the heart calling for more oxygen as the collateral’s developed to take up the job of the blocked arteries.

According to the cardiologist, my heart is on the way to being healed. I have to continue to exercise and push the heart, reduce some weight and continue a healthy lifestyle. Considering the other outcomes of serious surgery or death, those seem like attainable goals, right?  I quit smoking 10 years ago, lost 30 pounds and enrolled in a cardiac rehab program.

The key to natural bypass is heart health – stop smoking, reduce weight to a healthy level, avoid stress and endurance exercise.  It’s not a “best 2-or-3 out of 4”. Each treatment component plays a vital role in making your heart healthy again.

I have a fantastic wife, 10 children and 5 grandchildren with another on the way. That’s my grand-daughter in the featured image who came to visit after my heart attack last year. I hope to spend many more years enjoying my family thanks to this natural healing and cardiac rehabilitation.

Update – since I wrote this a new grandson was born (now 1), we have a new grandnephew (like a grand daughter) and another grand daughter coming this month. This life is full of riches greater than wealth.

As the article below says, not everyone can be helped with natural bypass and it is not a cure but a temporary relief of symptoms.  Heart disease requires medication and long-term changes in diet, lifestyle and activity levels.

How Natural Bypass works

By SteffenGloekler, MD, ChristianSeiler, MD – from Natural Bypasses Can Save Lives, American Heart Association

Collateral training results in a better blood supply of the heart and thus demonstrably fewer heart attacks, less severe loss of valuable heart muscle, better quality of life, and higher survival rates.

Figure 1. Influence of collateral supply on infarct size. A, Occlusion of a coronary artery with subsequent myocardial infarction. Before the occlusion occurred, the area of infarction (depicted in gray) was not supplied sufficiently by collateral vessels; thus, the size of the infarct comprises a large area (that is, the entire area at risk). B, Occlusion of the same coronary artery at the same site, but in this case, the area at risk was well supplied by collateral vessels (arrows). Therefore, this patient will have no infarction at all.

Figure 1. Influence of collateral supply on infarct size. A, Occlusion of a coronary artery with subsequent myocardial infarction. Before the occlusion occurred, the area of infarction (depicted in gray) was not supplied sufficiently by collateral vessels; thus, the size of the infarct comprises a large area (that is, the entire area at risk). B, Occlusion of the same coronary artery at the same site, but in this case, the area at risk was well supplied by collateral vessels (arrows). Therefore, this patient will have no infarction at all. Diagram by Steffen Gloekler, MD and Christian Seiler, MD

Blood to the heart muscle is provided by the left and right coronary arteries, which arise from the aorta and then branch into increasingly tinier vessels.

Each coronary artery supplies blood to its own area of muscle (Figure 1). In humans, very small, hairlike vessels (capillaries) are often the only interconnections between the coronary arteries and their service areas.

Sometimes, however, larger vessels interconnect the supplied areas. These vessels are called “collateral vessels” or “natural bypasses.” Only these collaterals, not the capillary network, are capable of delivering an adequate amount of blood to the heart muscle.

The extent of these natural bypasses varies from person to person and depends on individual conditions, such as hereditary factors, the degree of physical activity, and the existence of constrictions in the main coronary arteries, called “coronary artery disease.”

Myocardial Infarction – heart attack – Is a Major Cause of Death

In industrialized countries, coronary artery disease is a major killer. The disease is characterized by a general inflammatory process of the entire coronary artery system, with development of local deposits (called “plaques”) of lipids, cells of inflammation, connective tissue, and calcium.

This can lead either to progressively slow narrowing of the affected artery (which is typically sensed as angina pectoris) or a sudden rupture of a plaque (Figure 1) caused by its instability. In the latter situation, the downstream blood flow is abruptly blocked (which is the classic “heart attack” or myocardial infarction; Figure 1).

Factors That Determine the Size of an Infarct – heart attack

As a consequence of such a blockage, the section of heart muscle normally supplied by the vessel lacks “fuel,” that is, oxygen and nutrients, and it finally dies. If the patient survives, the final stage is a loss of cardiac pumping strength and a scar that replaces the former muscle.

The size of an infarction is not the same in every case: It is mainly influenced by the size of the blocked artery (that is, a larger artery supplies a larger area of muscle, the so-called area at risk), the duration of the blockage (that is, the damage is smaller when rapid reopening of the artery occurs), and importantly, the extent of blood flow through collaterals from neighboring vessels (that is, the more that collaterals can “step into the breach” to supply the starving muscle tissue in need, the smaller is the size of the infarction; Figure 2).

Figure 2. Coronary angiography with an example of the muscle- and life-saving impact of collaterals. In this patient, the right coronary artery (RCA) is filled with contrast agent. By a natural bypass, that is, the collateral channel (arrows), the left coronary artery (LAD), which is blocked at its origin (ring), is filled with blood. Without the collateral vessel providing blood to the large territory of the left coronary artery, this area would have died off; that is, the patient would have suffered a potentially deadly infarction.

Figure 2. Coronary angiography with an example of the muscle- and life-saving impact of collaterals. In this patient, the right coronary artery (RCA) is filled with contrast agent. By a natural bypass, that is, the collateral channel (arrows), the left coronary artery (LAD), which is blocked at its origin (ring), is filled with blood. Without the collateral vessel providing blood to the large territory of the left coronary artery, this area would have died off; that is, the patient would have suffered a potentially deadly infarction. Illustration by  Steffen Gloekler, MD and Christian Seiler, MD

In the ideal case, a very good collateral supply to the area at risk can make the infarct size shrink to zero when there is a sudden blockage of an artery.

In the worst case, when no or a very low collateral flow to the starving area of infarction is available, the infarct involves the entire area at risk of the supplying vessel, which is blocked.

Established Treatments for Coronary Artery Disease

Besides treatment with drugs, constricted vessels can be widened by inflating a balloon on a catheter (angioplasty) and, in most cases, also placing a wire tube (stent) to keep the vessel open. In an infarction, this is the superior therapy, because blood flow to the heart muscle is restored as quickly as possible, and damage can be limited. Coronary artery bypass grafting (CABG; pronounced “cabbage”) operation is needed if numerous severe constrictions near the outlets of the coronary arteries are present. Altogether, these technologies have led to enormous progress in the treatment of the disease in the last 30 years.

Treatment Limitations

As in every catheter-based intervention or surgical operation, there are risks related to the procedures. Apart from that, approximately one fourth of all patients are not suitable for these revascularization procedures at all.

These procedures do indeed repair the local problem of narrowings, but they do not alter the natural progression of the disease. Alternative treatment practices are therefore required to alter the course of coronary artery disease, alleviate angina pectoris, and thereby decrease the number of deaths due to infarction.

How to Turn the Capillary Network Into Collaterals

When there is increasing traffic volume on a highway, it may make sense to make the highway into a larger freeway to allow a higher traffic volume. In short, the same happens to the coronary arteries: When blood flow is increased, the inner layer of vessel cells (endothelial cells) sense this necessity and start the process of enlarging from capillaries into genuine collateral vessels.

In response to endurance exercise training (such as running, bicycling, swimming, and hiking), blood flow is increased, which leads to a conversion from capillaries into collaterals. This is a very elegant treatment everybody can accomplish. It reduces the chances of the occurrence of angina pectoris, myocardial infarctions, and death.

Beyond the interventional, surgical, and medical treatments against coronary artery disease, this collateral training is a natural and valuable therapy that many patients can apply by themselves, for themselves, if only they are aware of it.

Key Points

  • As a pump, the heart muscle is critically dependent on the coronary arteries for sufficient blood supply.
  • Narrowing of the coronary arteries by deposits (plaques) can starve the heart muscle of oxygen and nutrients. This results in chest pain (angina pectoris).
  • A heart attack results when a diseased coronary artery is blocked completely. As a consequence, the portion of the heart muscle normally supplied by this artery dies (myocardial infarction).
  • After a myocardial infarction, a certain mass of muscle is lost forever. Depending on infarct size, quality of life and life expectancy can be shortened.