DEAR READERS: Yesterday, I answered a question about treatments for heart failure. It's a big topic, and so today I'm talking about the medicines that are typically used to treat heart failure. As we discussed, heart failure is a condition in which the heart cannot pump efficiently enough to meet the body's need for blood. As a result, tissues and organs throughout the body don't get enough oxygen. Also, fluid builds up in the lungs and other body tissues. Taking heart failure medicines as prescribed is perhaps the single most important thing you can do to feel better and live longer. The medicines available today are dramatically more potent than the medicines that were available when I was in medical school.
DEAR DOCTOR K: I've been diagnosed with heart failure. Thankfully, it is still in the early stages. What can I do to keep it from getting worse?
DEAR READER: The function of the blood is to carry nutrition to every cell in the body and to carry away waste from the cell. The function of the heart is to keep pumping blood so that the blood reaches every cell in the body. Heart failure is a condition in which the heart cannot pump efficiently enough to meet the body's need for blood. As a result, tissues and organs don't get enough nutrition, and fluid builds up in the lungs and tissues.
DEAR DOCTOR K: You mention atherosclerosis in many of your columns. Could you explain what this word means?
DEAR READER: My readers ask me many questions about atherosclerosis, and for good reason: It is the No. 1 cause of premature death in developed nations, including the United States. Atherosclerosis is a narrowing of the arteries. Arteries are blood vessels that supply fresh, oxygen-rich blood to the heart, brain, intestines and other organs. The narrowing is caused by the buildup of plaques in artery walls. The plaques are filled with LDL cholesterol -- so-called "bad" cholesterol.
DEAR DOCTOR K: I've heard that coffee is good for your health -- but I've also heard that it increases your blood pressure and heart rate. What's true?
DEAR READER: Right now, the evidence I'm aware of points to health benefits for most people from regularly drinking coffee. I'm talking about straight coffee -- minus the cream and sugar. Straight coffee is a nearly calorie-free beverage brimming with antioxidants. There's evidence that drinking coffee might help prevent Type 2 diabetes and reduce the risk of heart disease and stroke. And studies show lower rates of gout and liver disease among regular coffee drinkers.
DEAR DOCTOR K: I have a clogged carotid artery. My doctor wants me to have an endarterectomy. Is this the best treatment option for my condition?
DEAR READER: It's impossible to answer your question without a lot more information. What I can do is describe what a clogged artery is, and what some of your treatment options are. The carotid arteries of the neck carry oxygen- and nutrient-rich blood from the heart to the brain. Deposits of fat and cholesterol -- plaque -- on the walls of the carotid arteries increase the risk of a stroke. Plaque can block blood flow to part of the brain. Or, a piece of it can break loose and completely block a smaller vessel in the brain.
DEAR DOCTOR K: I had a heart attack several years ago. I have been taking low-dose aspirin ever since to prevent a second one. Do I need to worry about bleeding risks?
DEAR READER: Every medicine contains risks as well as benefits. The question with any medicine is: Do the benefits outweigh the risks? Aspirin helps prevent repeat heart attacks in two ways. A heart attack occurs when the flow of blood through one of the heart's arteries is blocked.
DEAR DOCTOR K: What is a pulmonary embolism?
DEAR READER: A pulmonary embolism occurs when a blood clot (called an embolus) suddenly blocks a blood vessel in the lung. A small pulmonary embolus can happen without causing any symptoms, but a large pulmonary embolus can suddenly threaten your life. To explain pulmonary embolism, let's begin with a refresher on the circulation of blood in our bodies. Blood carries nutrients (like oxygen and sugar) to the cells of our body and removes waste material from the cells. The blood circulates because of the pumping action of the heart.
DEAR DOCTOR K: Every winter my wife worries that I am going to have a heart attack while shoveling snow. Does she have cause for concern?
DEAR READER: She does. Each winter, more than 1,200 heart-related deaths occur during or after snowstorms. Shoveling snow is risky for many reasons: Shoveling is similar to weight lifting. Resistance exercise raises both heart rate and blood pressure, stressing the heart. Cold weather affects the heart. To conserve body heat in the cold, blood vessels narrow. This raises blood pressure and puts stress on the heart.
DEAR DOCTOR K: I have a bad temper. Could my anger trigger a heart attack?
DEAR READER: You've seen it in movies: A character shouts in anger -- then drops to the floor clutching his chest. But this isn't just a movie scenario. Research shows that in the two hours after an angry outburst, a person has a slightly higher risk of having heart trouble. By heart trouble, I mean chest pain (angina), a heart attack, or a dangerous heart rhythm that can lead to sudden death. The person also is at higher risk for having a stroke.
DEAR DOCTOR K: What is a heart murmur? How is it treated?
DEAR READER: A heart murmur is a sound made by turbulent blood flow within the heart. (Think whitewater rapids as opposed to a gently flowing river.) Your doctor hears this sound with a stethoscope. Most often, a murmur occurs in a healthy heart. Sometimes, people have murmurs just with a normal flow of blood through their hearts.