Congestive Heart Failure
Congestive Heart Failure has many causes
By Paul G. Donohue, M.D.
DEAR DR. DONOHUE: At first, doctors thought I had pneumonia. Then they decided I had congestive heart failure. How can such a mistake be made? I am now taking all sorts of medicines. Before, I wasn't taking any. Will I ever get off them? I am 79. N.N.
ANSWER: Pneumonia and congestive heart failure have two things in common: Both fill (congest) the lungs with fluid, and both make a person short of breath. With pneumonia, the fluid in the lungs is filled with white blood cells trying to fight off the infection. With congestive heart failure, the fluid in the lungs is fluid that has leaked from the circulation due to a backup of blood in lung blood vessels. The two can be mistaken, but the error is usually quickly corrected.
Congestive heart failure results when the heart is no longer a good pump. Its muscle has become so feeble that it can't empty all the blood in it. Pressure inside lung blood vessels rises and forces fluid into the lungs' air sacs. Air can't get into or out of the lungs. Slight effort makes a person pant for air. Lying down often precipitates an attack of breathlessness. When heart failure becomes more severe, people waken from sleep gasping for breath.
Causes of heart failure are many. A heart attack can weaken heart muscle and its ability to pump. Deformed heart valves are another cause. Uncontrolled blood pressure can bring on heart failure.
Medicines can often get the heart pumping more strongly. Water pills rid the body and lungs of excess fluid. ACE inhibitors take the stress off heart muscle. Digitalis, the old standby of heart failure treatment, is still used in some circumstances. There are many more medicines, and, yes, a person often must take a combination of them. More likely than not, you will have to take them for life.
The booklet on congestive heart failure provides more facts on this very common disorder. Readers can obtain a copy by writing: Dr. Donohue No. 103W, Box 536475, Orlando, FL 32853-6475. Enclose a check or money order (no cash) for $4.75 U.S./$5.75 Canada with the recipient's printed name and address. Please allow four weeks for delivery.
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DEAR DR. DONOHUE: I have arthritis of my knees. It's tolerable, but it does cause me not to participate in many things I would like to do. My doctor suggests a series of shots with Synvisc. I am leery of shots into joints. I hear they do more harm than good. Is Synvisc cortisone? M.J.
ANSWER: Synvisc is hyaluronic acid, not a cortisone medicine. Hyaluronic acid is a normal constituent of joint fluid. It's a viscous substance that lubricates the joint. It's sort of like high-grade oil. With osteoarthritis the most common kind of arthritis joint fluid thins, and the joint hurts because it isn't well-lubricated.
Injections of Synvisc are not painful, and they do not harm the joint. They do some people a world of good.
Dr. Donohue regrets that he is unable to answer individual letters, but he will incorporate them in his column whenever possible. Readers may write him or request an order form of available health newsletters at P.O. Box 536475, Orlando, FL 32853-6475. Readers may also order health newsletters from www.rbmamall.com.
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