Valentine’s Day usually brings attention to romance. In my practice, it sometimes becomes a moment to reflect on the heart itself, especially when patients continue to struggle despite appropriate care.
This is a composite case, with identifying details changed.
Meeting RJ
I met RJ, a 68-year-old man with hypertension, high cholesterol, type 2 diabetes, and a prior mild heart attack, after he had already been followed closely by his traditional cardiologist.
Despite taking all recommended medications, he remained significantly limited by symptoms. When he described his daily life, the pattern was clear. Walking one or two blocks caused chest discomfort. One flight of stairs left him short of breath and fatigued. Ordinary activities required planning and caution.
A coronary angiogram performed as part of his standard cardiology care showed diffuse coronary artery disease. There were no discrete blockages that could be treated with stents or bypass surgery. From a procedural standpoint, options were limited.
How I Thought About the Problem
When I evaluate angina, I usually begin with the familiar framework of oxygen supply and demand. In RJ’s case, that framework had already guided appropriate treatment. His coronary anatomy had been defined, and medical therapy optimized.
What stood out to me was how quickly his symptoms appeared at relatively low levels of exertion. That raised a different question: not whether blood was reaching the heart, but how effectively the heart muscle was using what it received.
Thinking at the Cellular Level
Every heart muscle cell relies on mitochondria to produce ATP, the energy required for contraction, relaxation, and cellular repair. In patients with diabetes, aging myocardium, and chronic ischemic disease, mitochondrial efficiency is often reduced.
When energy production becomes limited, the heart may struggle even when oxygen delivery appears adequate. Clinically, this often presents as early fatigue, disproportionate shortness of breath, and chest discomfort with minimal effort.
As I thought through RJ’s symptoms in this context, his limitations made more sense. The issue was less about a correctable blockage and more about an energetically strained myocardium.
Supporting Function Rather Than Anatomy
At this stage, my focus was not on fixing anatomy, but on supporting function.
Alongside the medications prescribed by his traditional cardiologist, I looked at ways to support myocardial energy production and reduce ongoing inflammatory stress.
From a metabolic standpoint, I used supplements with established roles in these pathways:
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Coenzyme Q10, which participates in mitochondrial energy production
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Acetyl-L-carnitine, which helps transport fatty acids into mitochondria for fuel
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D-ribose, which supports ATP regeneration
These were used selectively and thoughtfully, based on his overall medical picture.
We also addressed inflammatory load through dietary changes and, after reviewing his medications, added omega-3 fatty acids and curcumin.
Non-nutritional factors mattered as well. I paid close attention to sleep patterns, stress physiology, and physical conditioning. Supervised cardiac rehabilitation allowed exercise to be introduced safely and progressed gradually.
What I Observed Over Time
Over the following months, RJ’s functional tolerance improved. He was able to walk farther with less chest discomfort and relied less on nitroglycerin. More importantly, he felt steadier and more confident engaging in daily activities.
There was no single turning point. The improvement reflected cumulative physiologic changes rather than one discrete intervention.
Closing Reflection
Cases like RJ’s remind me that heart disease is not only a problem of narrowed arteries, but also of how the myocardium adapts when those arteries cannot be changed.
When anatomy sets limits, function becomes the focus. Paying attention to energy metabolism, inflammation, conditioning, and recovery often reveals room for improvement that is not immediately.
*This article is intended for educational purposes only and is not medical advice. Individual care decisions should always be made in consultation with your own healthcare provider.
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