|
|
|
April 17, 2003
Living with congestive heart failure
Q: When I sit, I breathe fine. When I walk, l am quickly out of breath. l have the same trouble when I lie down in bed. Some nights I wake gasping for air. My doctor says I have congestive heart failure. Where’s the congestion? Why the failure? I never had a heart attack. Can I live with this?
A: In North America, more than 5 million people suffer from congestive heart failure, and it is one of the most common reasons why people are admitted to the hospital. Yes, people can live with it.
The basis of heart failure is the inability of the heart to pump sufficient quantities of blood to keep the body in motion. A weak heart muscle, often the result of blocked heart arteries or old heart attacks, is a preeminent cause of heart failure. The heart is so feeble that it cannot eject normal amounts of blood. Blood backs up into the lungs (congests them), and that is one reason why labored breathing is such a prominent complaint of heart failure. Ankles swell because leg veins become engorged with blood and leak fluid.
Or, the heart muscle can become so stiff that it can no longer hold the normal amount of blood. Once again, blood backs up and congests the lungs, many organs and veins. This kind of heart failure also makes breathing labored.
When lying flat in bed, more fluid seeps into the lungs, and that compounds the congestion. Waking up gasping for breath is another sign of lung congestion. Walking puts greater demands on the heart, and the lungs become soaked with fluid that seeps out of blood vessels.
Things you can do on your own to lessen symptoms are a strict rationing of salt and avoidance of alcohol. Propping the head of the bed with blocks under the bedposts can make night-time breathing less laborious.
Medicines are always needed. Diuretics rid the body of excessive amounts of fluid, and that eases the pressure on the heart. New heart-failure medicines include Capoten, Vasotec, Prinivil, Coreg, Lopressor and Zebeta. These drugs have made heart failure treatment much more effective than it was in the past. Digoxin (digitalis) is an old and venerable standby.
Q: During the Christmas holidays, l spent two weeks with my daughter and her four children. I was appalled by how much chocolate milk those kids drink. Is chocolate milk healthy?
A: Chocolate milk has the same amount of vitamins and minerals (calcium) that white milk has. It has more sugar than white milk, so one glass contains roughly 60 more calories. Chocolate milk comes in low-fat varieties, and they reduce its calorie, fat and cholesterol load.
The caffeine in chocolate milk is insignificant. Chocolate milk is not going to cause your grandchildren health problems now or later.
Q: I complained to my doctor of lack of air when exercising. The doctor ordered a stress electrocardiogram. He said it was normal. He could not explain the sentences underlined in red (in the enclosed report). Can you interpret them for me?
A: The sentences are: “There is an upsloping ST segment depression in leads 2, 3 and aVF at peak exercise. Probably abnormal exercise treadmill tolerance test.” You also had an echocardiogram done at the same time, and it was interpreted as normal.
The ST segment is one short segment of the ECG. Depressions of the ST segment can indicate a lack of blood supply to the heart muscle. Leads 2, 3 and aVF indicate that the changes are taking place in the bottom of the heart. Upsloping changes are generally insignificant. I cannot tell you why the interpretation reads “abnormal.”
The normal echocardiogram takes precedence over the ECG stress test. I too am puzzled. Your doctor owes you a clarification on the conflicting statements. —2003 North America Syndicate Inc.
|
|
|
|
