Treatments available for those with a ‘stiff heart’
Dear Dr. Roach: A friend of mine has been diagnosed with “stiff heart” and has kind of given up because there is no treatment. With all the advances in medicine, isn’t there something that can be done?
C.L.
Answer: It’s not always easy to guess what a medical diagnosis might be from a simplified description like this, but my best guess is that your friend has a type of heart condition called “heart failure with preserved ejection fraction” (HFpEF).
The left ventricle, which is the chamber of the heart that provides oxygenated blood to the body, is indeed stiff, requiring high pressures to fully fill the chamber. The damage to the heart in HFpEF can come from many conditions, including high blood pressure, diabetes, obesity, blockages in the arteries, atrial fibrillation, kidney or lung disease, sleep apnea, and just getting old.
Whenever possible, the underlying conditions should be treated. Specific treatment for HFpEF can be frustrating, but medical advances are catching up. New classes of medicines have been shown to improve symptoms.
If a person has volume overload (such as swelling in the legs or lungs), they will need to lose the fluid with a diuretic. Once the excess fluid is removed, treatment with a sodium-glucose cotransporter-2 (SGLT2) inhibitor and a mineralocorticoid receptor antagonist has been shown to improve symptoms and outcomes.
In people who are obese with HFpEF, the use of semaglutide has been shown to improve their exercise ability and quality of life, and it has just received an indication by the Food and Drug Administration to protect the heart in this situation.
However, there are other possibilities, such as amyloidosis. It has specific treatments depending on the type of amyloidosis, in addition to the treatments mentioned above for heart failure.
Dear Dr. Roach: I am just getting over the horrible shingles. I thought I had chicken pox when I was younger, but I got shingles anyway two months ago. It is horrible and debilitating with nerve pain and rash pain after the blisters start to disappear. Once this miserable thing passes (if it ever does), should I get the new and improved shingles vaccine at some point, or am I good to go for a while? I’m 77 and still in basically good health.
H.B.
Answer: Just to clarify, you got shingles because years ago, you did have chicken pox. The chicken pox virus is called the varicella-zoster virus because it causes chicken pox (varicella) and shingles (zoster). You get shingles when your immune system is weakened, which can happen when we get older or when we are stressed. As you correctly say, shingles can be miserable, with pain that can persist for weeks or months (or even years).
Unfortunately, people can get shingles more than once, so you should absolutely get the newer, two-dose Shingrix vaccine, which reduces the risk of shingles by as much as 97%. You can get the vaccine as soon as the lesions are all crusted over, but it’s not urgent to get it right away, although I wouldn’t let a year go by.
People have asked me about getting a second complete vaccine sequence after getting shingles, despite getting vaccinated with the new vaccine. They also ask about getting the vaccine at an age younger than 50. I can’t answer these as there aren’t good data, but these kinds of cases need to be handled individually by the person’s doctor. There are times when it is reasonable to use the shingles vaccine at a younger age or as a second dose.
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.cornell.edu or send mail to 628 Virginia Drive, Orlando, FL 32803.