September 15, 2008

Dr. Donohue: Big Heart Has to Be Slimmed

By Dr Donohue

Q: My husband, 68, has just been told he has hypertrophic cardiomyopathy. His cardiologist suggests treatment with alcohol ablation. I know this is fairly new, and I wonder how safe it is and if the results are worth the risks. He has tried medicine, but the condition has gotten worse. What can you tell us about this procedure?

A: "Cardiomyopathy" indicates that the heart trouble lies in the heart muscle, not the arteries that bring blood to the heart (the most common kind of heart disease) or in the heart valves (another common heart problem). "Hypertrophic" refers to an overgrowth of the heart muscle, with large muscle fibers laid down in disarray.

Hypertrophic cardiomyopathy can have no symptoms, or it can be disabling and potentially deadly. The too-muscular heart leaves little room for blood in the pumping chamber and can obstruct the flow of blood out of the heart. Symptoms include shortness of breath, chest pain, fainting episodes and periods of abnormal and dangerous heartbeats.

When medicines cannot control symptoms, then doctors have to intervene with invasive procedures. The one suggested to your husband is one of them. It's not brand-new. Alcohol is injected into heart arteries that feed the section of heart muscle causing problems. The injection is accomplished through a catheter (a spaghetti-size tube) passed through a surface blood vessel to the designated heart vessel. Alcohol pares away the excess muscle. It's one good way of solving a difficult problem.

Q: You wrote that normal blood pressure is below 120/80. I would like to know how far below. I am 70 and a healthy, slim man who has never been on any kind of medicine. My blood pressure readings average in the range of 110-115/55-65. The lowest ever readings were 81/53 and 83/54. Both were taken right after I got up in the morning.

A: People whose pressures are lower than 120/80 live longer lives. What numbers are too low? It doesn't so much depend on the numbers, but on symptoms like lightheadedness, sweating, weakness, fainting or feeling on the verge of fainting. If you have none of these, your pressure is fine. When the first number is less than 80, it's hard for blood to circulate into the brain, and symptoms are common then. The low pressures upon getting out of bed reflect orthostatic hypotension, a drop in pressure on standing. It happens to older people because reflexes that normalize blood pressure in such situations become less active with age.

Dr. Paul Donohue appears Mondays. Write to him at P.O. Box 536475, Orlando, FL 32853-6475.

Originally published by Dr. Donohue, North America Syndicate.

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