DEAR DRS. DONOHUE AND ROACH: I am 71 years old and have been diagnosed with chronic heart failure. In October of last year, I had triple bypass surgery, but now I'm in good health. Some things I have read about chronic heart failure are unnerving. Will you give me your take on what lies ahead for me? -- S.T.
ANSWER: Heart failure, chronic heart failure and congestive heart failure are the same condition. It's one of the most common reasons why older people are hospitalized. The basic problem is that the heart has become so weak that it circulates blood poorly. Such poor circulation permits fluid to ooze out of blood vessels and "congest" tissues in the feet, ankles and lower legs. The lungs fill with fluid, which brings on heart failure's cardinal feature -- gasping for breath on even slight exertion.
Other signs of heart failure are breathlessness when lying in bed, heart enlargement, seen on X-rays, and the doctor's discovery of lung sounds that indicate the lungs have fluid in them.
Numerous conditions lead to heart failure. At the top of the list is coronary artery disease, blockage of heart arteries that often brings on a heart attack. This must be why your heart failed. You did have surgery to correct blocked heart arteries, but they did their damage well before surgery took place. Heart valve problems, high blood pressure and atrial fibrillation are other causes of heart failure.
Medicines usually can get the heart beating with greater vigor and can lessen or abolish most symptoms. Anything that affects heart function must be treated. High blood pressure, for example, has to be lowered.
You might think that inactivity is best for your heart; it isn't. Your doctor will outline a program that keeps you active to the level that your heart can tolerate. Walking is one example, but more strenuous exercise is encouraged when your heart becomes stronger. You should be on a low-salt diet.
You ought not to be discouraged about your outlook. The life span of people with congestive heart failure has increased by 15 percent in men and by 5 percent in women in just the past decade. The increment in women's life span is smaller because women live longer, on average, than men.
Readers can order the booklet on congestive heart failure by writing: Dr. Donohue -- No. 103, Box 536475, Orlando, FL 32853-6475. Enclose a check or money order (no cash) for $4.75 U.S./$6 Can. with the recipient's printed name and address. Please allow four weeks for delivery.
DEAR DRS. DONOHUE AND ROACH: I am 84 and have heart failure, diagnosed four years ago. I had a pacemaker put in for atrial fibrillation. I take a number of medicines. My heart doctor says I might need a stent in my heart artery. I am anemic and take vitamin B-12 shots. Why am I tired a lot of the time? Why am I out of breath often? Would it do me any good to lose weight? I am 5 feet 7 inches tall and weigh 175 pounds. Would walking help? -- J.B.
ANSWER: What I said in the former letter also applies to you. Your anemia can make you tired and short of breath. You are under treatment for anemia (pernicious anemia) with the B-12 shots. I don't know how long you've been taking the shots, but they should correct the anemia shortly. Your symptoms should improve then.
You don't need to lose weight. Your body mass index is 27.4, which means you are only slightly overweight.
Have you spoken to the doctor about your shortness of breath and lack of energy? Heart failure can be responsible for both. Perhaps a change or addition to your medicines would help. An ACE inhibitor, for example, is nearly always included in a heart-failure program. Names are Vasotec, Zestril and Altace. You need some physical exercise, but the exact amount has to come from your heart doctor.
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Drs. Donohue and Roach regret that they are unable to answer individual letters, but will incorporate them in the column whenever possible. Readers may write the doctors or request an order form of available health newsletters at P.O. Box 536475, Orlando, FL 32853-6475. Readers also may order health newsletters from www.rbmamall.com.
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