Dei'ah veDibur - Information & Insight

A Window into the Chareidi World

7 Shevat 5761 - January 31, 2001 | Mordecai Plaut, director Published Weekly








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Home and Family
Your Medical Questions Answered!
by Joseph B. Leibman, MD

Diplomate, Board Certification of Emergency Medicine

Chairman, Department of Emergency Medicine Ma'ayenei Hayeshua Hospital

As we mentioned last time, there are diseases of the lungs that come from other places. One of the most common ones is probably the most serious illness I see. It is called by a scary name: "Congestive Heart Failure" or CHF; but it really isn't failure in the sense that the heart stops working. Rather, the heart begins to pump inefficiently and instead of blood going forward, it backs up into the lungs and they fill up with fluid. Shortness of breath ensues and blood pressure goes sky high in order to help the blood go forward even more. However, the heart is weak and this makes matters even worse. The patient is very short of breath, pale, sweating, and may have a frothy cough or wheezing. He may have swollen legs.

CHF occurs with a weakened heart, usually from a past heart attack. The direct cause is usually from a small period of lessened oxygen delivered to the heart. In the past we thought it was from fluid overload from overeating salt; this is not thought to be a major cause at this point. When there is an acute attack, it is easy to diagnose this disease, but we can get warnings beforehand by calculating ejection fractions. This is the amount of blood pumped out of the heart every beat (there always remains a little blood left behind, but it shouldn't be that much).

If there is serious impairment, therapy to prevent CHF can be done. This is best accomplished by drugs such as diuretics ("water pills," that is they increase urination); nitrates which increase oxygen delivery to the heart by opening vessels, beta blockers in small doses and most importantly drugs called Ace inhibitors. These last two drugs make the heart's work easier and they are the only drugs that have been shown to increase life expectancy in this disease.

Some people are so impaired they cannot even walk a few feet without becoming short of breath; these patients often need supplemental oxygen all the time and some receive medicines intravenously that increase the heart's ability to pump. If these people are young, they are the ones that must be considered for heart transplants. There are some places in Europe that are doing heart-size reduction surgery in order to remove poorly functioning heart muscle and make pumping more efficient.

People with CHF who have reasonable ejection fractions can live normal lives, and will help themselves with a vigorous, doctor-supervised exercise program. There are now many heart rehabilitation centers that specialize in this. Still, if you want to prevent this disease from occurring, then your best bets are the usual things we have been trumpeting all along: lose weight, exercise, reduce stress, reduce blood pressure; take care of yourself and screen yourself for heart disease, and of course stop smoking. Write me in care of the Yated.

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