Questions will be posted below:

We have recieved great questions from our readers and will attempt to respond to them all.

Cindy from Kerrville, Tx:

Im an 88 year old female with recurring headaches caused by nitroglycerin, my other symptoms inlcude fatigue and difficulty breathing. My doctor said an operation is all that can be done? Do I have other options?

Dr. Jaski's answer:

There are many causes for shortness of breath including a leaky mitral valve. Normally, the mitral valve allows blood into the left ventricle when it is filling and should close when the heart is contracting. When the mitral valve has a severe leak, increased fluid pressure behind the heart can cause the lungs to become distended with fluid--a condition called pulmonary edema.  Reduced forward heart delivery of blood to the body can contribute to symptoms of fatigue. A definitive therapy for severe conditions could include surgery to repair or replace the leaky valve when a patient's general condition would permit this. Medical management through diuretics (medicines that increase the excretion of salt and water by the kidneys) may decrease fluid overload of the lungs and improve shortness of breath. Medicines that dilate blood vessels can also reduce an increased fluid pressure. A diet low in intake of sodium can reduce the fluid pressures within the circulation and also help.  A decision for surgery should be thought about carefully due to increased risks associated with older age.

Anonymous:

My father is suffering from shortness of breath and also wakes so much in the night, i.e. 5 times an hour. Walking from the house to the car and then a short walk to a shop is too much for him. The General Practitioner states the fluid in his lungs is the cause of the shortness of breath. Would oxygen or a nebulizer help?

Dr. Jaski's answer:

Congestive heart failure has many symptoms, but the most dominant, shortness of breath, can be caused by fluid buildup in the lungs. Although inhaled oxygen might temporarily help symptoms of difficulty breathing at night, it might be better to try to get to the root causes. Fluid congestion at night can often be improved over time by reducing sodium intake in the diet or increasing the doses of diuretics.  Medicines that dilate blood vessels can also reduce vascular pressures that contribute to fluid buildup in the lungs. Your father's doctor could also answer whether there are any treatable conditions that could fundamentally improve your father's heart function as a pump such as excessive high blood pressure, blocked heart arteries, or impaired heart valves.  

Cindy from Marysville, WA:

My 93 year old grandmother has CHF and has a pacemaker.  She has been spitting up frothy white sputum for years.  She is currently in a nursing facility recovering from weakness related to an intestinal bleeding issue.  While in the nursing facility she has developed a cough (unrelated to an upper respiratory infection).  They are giving her Albuterol treatments every 4 hours.  The past 2 days she has been hallucinating off an on.  Is it possible that her CHF is causing her oxygen saturation to drop such that it is causing her mental status to change? 

Dr. Jaski's answer:

Your grandmother could experience symptoms of dizziness if her heart failure led to a frequently low  blood pressure or oxygen saturation in her blood. With advanced heart failure, memory or analytical thinking may be impaired. In general, when elderly individuals have hallucinations, causes besides heart failure that could affect brain function should be considered.

Debopom Goswami from India:

What is the recomended treatment stradegy for a patient with pneumonia and heart failure?

Dr. Jaski's answer:

Both pneumonia and heart failure are common conditions that can result in shortness of breath. By definition, pneumonia is an inflammation that results in filling of the air spaces of the lungs—usually due to infection. Heart failure can also result in congestion of the lung air spaces by salt and water displaced from the circulation because of a high fluid pressure “backed up” behind the left ventricle. On a chest x-ray, different distributions of opacification of the lungs can help distinguish the two conditions. Pneumonia is usually associated with fever. Heart failure may be associated with other findings of fluid retention including elevation of a heart failure blood test.  Nevertheless, especially in patients with a history of heart disease, distinguishing between the two conditions can be difficult including the possibility that both could be present at the same time. Whereas pneumonia usually requires antibiotics to improve, heart failure with lung congestion may need therapies to increase the removal of excess salt and water from the body.

Aishah:

My 74 year old grandmother was recently diagnosed with heart failure. Doctors claim she has just 29% of her hearts life left. She is diabetic and has high blood pressure as well. She recently became very ill when fluids filled up in her lungs leading to breathing issues and an increased heart rate. While in the hospital she had to receive cardioversions twice to reduce her heart rate.

Kindly advise me on what precautionary measures we can take and what we can expect for her future health.

Dr. Jaski's answer:

Several important points emerged from your question. First, Ejection fraction- The amount of blood ejected by the heart with each beat as a fraction of what it starts with at the beginning of a beat. For example, if the heart has a 100ml of blood at the beginning and ejects 60ml leaving 40ml, which would be an ejection fraction of 60%. If the heart were to flatten like a pancake when it contracted, the ejection fraction would then be 100%. Normally the heart ejects about 2/3 of the blood it starts with at the beginning of a beat. So if your grandmother has an ejection fraction of 29%. That is seriously decreased but it's not 29% of 100%, but 29% of a normal range of 55-75%.

Secondly, your mother was given a diagnosis of "Heart Failure", I like to use the analogy of a car, this would be like a mechanic saying you have engine trouble. The question is why? For example is there a problem with her heart arteries ("fuel lines"). Is her heart muscle weak despite an adequate blood supply ("bad cylinders"). Does she have a problem with the element activation of her heart (" a problem with the distributor"). The answer to these questions may lead to specific therapies that could help her.

Lastly, In general, there are recommendations that should come from her doctor and medical team, including medication, diet and exercise. Please look at the sections in our website specific to these topics which may help.