Heart failure treatment often effective

→DEAR DR. GOTT: We have a friend who says she has heart failure and edema. We would like to know what this is, as we have never heard of it before.

→DEAR READER: Heart failure means that the heart cannot pump adequate blood to meet the body’s needs. It generally develops slowly after one or more conditions have damaged or weakened the heart. Some of the more common causes of heart failure are coronary-artery disease, heart attack, hypertension, myocarditis (inflammation of the heart muscle) often caused by a virus, arrhythmias, faulty heart valves, cardiomyopathy and severe anemia. Still other contributing diseases include diabetes, emphysema, hyperthyroidism or hypothyroidism and hemochromatosis. While many of the conditions that lead to heart failure cannot be reversed, the failure itself can often be treated successfully.

Signs and symptoms include shortness of breath, rapid or irregular heartbeat, a decreasing ability to exercise, fatigue, weakness, edema (swelling) of the lower extremities, chest pain if the failure is caused by a heart attack and increased abdominal girth (ascites).

For a physician to make a proper diagnosis, he or she will likely perform a physical exam that includes, in part, checking blood pressure. The stethoscope that is used to check blood pressure will be used to listen to your lungs for any signs of congestion and to detect abnormal heart sounds suggestive of failure. Beyond that, an electrocardiogram (EKG), chest X-ray, echocardiogram and blood testing might be included. More sophisticated testing, if necessary, includes a stress test, angiogram, and MRI or CT scanning.

As an initial step, medicine is commonly prescribed for treatment. Depending on the symptoms, more than one drug might be taken for optimal control. Angiotensin-converting enzyme (ACE) inhibitors dilate blood vessels and lower blood pressure. They improve the quality of blood flow and lower the heart’s workload. Unfortunately, some drugs in this category can produce what is known as an ACE inhibitor cough. For those people unable to deal with the side effect, there are alternative angiotensin II receptor blockers. There is digoxin to increase the strength of contractions of the heart muscle, beta blockers to decrease the heart rate and blood pressure simultaneously, diuretics that reduce or prevent fluid retention and more.

If surgery is recommended, appropriate specialists have the capability of performing coronary bypass, installing implantable defibrillators, pacemakers, left-ventricular assist devices and, finally, heart transplant. Experimental procedures include cardiac wrap, where a failing heart is wrapped in a mesh bag to prevent a weak heart from further enlargement; removal of scar tissue in the ventricular muscle caused by a myocardial infarction; and applying inflatable pressure cuffs on the calves, thighs and buttocks with the intent of increasing the flow of blood back to the heart muscle.

There is a great deal a person can do to prevent heart failure from worsening. The process begins by restricting salt intake, discontinuing smoking, avoiding saturated and trans fats in the diet, exercising appropriately and reducing stress.

To provide related information, I am sending you a copy of my health report "Coronary Artery Disease.” Other readers who would like a copy should send a self-addressed, stamped, business-size envelope and a check or money order for $2 to Newsletter, P.O. Box 167, Wickliffe, OH 44092. Be sure to mention the title.

→DEAR DR. GOTT: I’m a retired physician. My ankles and legs have been swelling, and my sense of balance has been worsening. So, I exercise by standing on one foot. The swelling is gone and my balance is improved.

→DEAR READER: This approach and the use of pressure stockings have been adopted by specialists to treat lymphedema.

You have apparently rediscovered a way to treat the complications of swelling. Good work. I’ll pass on your tip.

Readers may send a question to Gott c/o United Media, 200 Madison Ave., 4th Floor, New York, NY 10016. Gott is a retired physician and author of "Dr. Gott’s No Flour, No Sugar Diet” and "Dr. Gott’s No Flour, No Sugar Cookbook,” available at most bookstores.

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