This con­ges­tive heart fail­ure needs a spe­cial­ist

Cape Breton Post - - ADVICE/GAMES - Dr. Roach re­grets that he is un­able to an­swer in­di­vid­ual let­ters, but will in­cor­po­rate them in the col­umn when­ever pos­si­ble. Read­ers may email ques­tions to ToYourGoodHealth@med.cor­ or re­quest an or­der form of avail­able health news­let­ters at 628 Vi

DEAR DR. ROACH: My hus­band was di­ag­nosed with con­ges­tive heart fail­ure a year ago. His ejec­tion frac­tion was 15-20. Now it is 25-30, but he’s worse! For the past few months, he’s been ad­mit­ted to the hos­pi­tal at least once a week. It started with an over­load of 13 liters; he came home, and within a few days was un­able to keep his blood pres­sure up and was read­mit­ted for de­hy­dra­tion. They loaded him up on flu­ids, sent him home a few days later, and he was over­loaded again. His kid­neys get “in­sulted” ev­ery time he gets de­hy­drated. How do you find the balance? This flip-flop­ping ev­ery week is so old. -- D.E.

AN­SWER: Con­ges­tive heart fail­ure is not a sin­gle dis­ease; it’s a syn­drome of in­ad­e­quate blood flow from the heart to meet de­mand. It has many dif­fer­ent causes, but the most com­mon are long­stand­ing high blood pres­sure, heart at­tacks and di­lated car­diomy­opa­thy, which it­self of­ten is caused by a virus but can be caused by al­co­hol or some chemo­ther­a­pies.

One mea­sure­ment of heart fail­ure is the ejec­tion frac­tion, the amount of blood pumped out by the left ven­tri­cle with ev­ery beat. That’s nor­mally be­tween 50 per­cent and 75 per­cent or so, but be­cause the heart can di­late (en­large), an ejec­tion frac­tion of 15 per­cent might cause only mild symp­toms or might be in­com­pat­i­ble with life. Fur­ther, med­i­ca­tions that im­prove the ejec­tion frac­tion can make symp­toms worse in some peo­ple.

When the heart is as pre­car­i­ous as your hus­band’s, it is very dif­fi­cult to man­age fluid. Too lit­tle fluid, and the heart can’t pro­vide enough blood for crit­i­cal or­gans -- in which case, the kid­neys fre­quently are dam­aged. Too much fluid, and the heart fails and the lungs be­come con­gested, as can the ab­dom­i­nal cav­ity.

Heart fail­ure this se­vere de­serves an ex­pert. Gen­eral in­ternists like my­self can man­age many peo­ple with heart fail­ure, but a car­di­ol­o­gist, or even a car­di­ol­o­gist with spe­cial ex­per­tise in heart fail­ure, can make a big dif­fer­ence. Care­ful man­age­ment of med­i­ca­tions might help him a lot. Un­for­tu­nately, some peo­ple will re­quire more dras­tic treat­ments, such as a left­ven­tric­u­lar-as­sist de­vice or a heart trans­plant. Not ev­ery­one is a good can­di­date for th­ese ther­a­pies.

READ­ERS: Heart dis­ease re­mains the No. 1 killer. The book­let on clogged heart ar­ter­ies ex­plains why they hap­pen and what can be done to pre­vent clog­ging. Read­ers can ob­tain a copy by writ­ing:

Dr. Roach, Book No. 101, 628 Vir­ginia Dr., Or­lando, FL 32803 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 DR. ROACH: I’m a 63-year-old male in decent health, but with an age-re­lated en­larged prostate. I take fi­nas­teride and tam­su­losin daily. When I talked to my doc­tor about this, I got the idea that this med­i­ca­tion works by low­er­ing my testos­terone, but my daugh­ter says that might not be the case.

I re­cently joined an ex­er­cise pro­gram that is sup­posed to in­crease my testos­terone lev­els and help me lose some belly fat (I’m maybe 20 pounds over­weight). Will this cause me any prob­lems, and will this in­crease my risk of prostate cancer? -J.K.

AN­SWER: Tam­su­losin (Flo­max) works by re­lax­ing mus­cles in the prostate gland that block urine flow, so it starts work­ing right away. Fi­nas­teride (Proscar) works not by block­ing testos­terone, but by pre­vent­ing the body from mak­ing di­hy­drotestos­terone, which in­creases prostate size and causes hair loss (maybe your daugh­ter has read up on it). The pre­pon­der­ance of data show that fi­nas­teride causes no in­crease in prostate cancer risk.

Re­sis­tance ex­er­cise in­creases testos­terone pro­duc­tion, but the testos­terone does not stay long in cir­cu­la­tion. Ex­er­cise may re­duce the risk of de­vel­op­ing prostate cancer in the first place, and is likely to slow pro­gres­sion in peo­ple who have early prostate cancer. It’s yet another rea­son that reg­u­lar ex­er­cise is ben­e­fi­cial.

Keith Roach

To Your Good Health

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