Leaky heart valve causes heart enlargement

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DEAR DR. DONOHUE: My doctor had me get an echocardiogram (report enclosed). He said I have an enlarged heart, but he didn’t explain it. Will you please give me more information? — L.R.

 ANSWER: Your main heart problem is a leaky aortic valve, one of the four heart valves. The enlarged heart is a result of that leak.

 After the heart pumps blood into the aorta — the heart artery that carries blood to the other body arteries — the aortic valve closes to prevent backflow of blood. A leaking aortic valve permits blood to flow back from the aorta into the left ventricle, the heart’s main pumping chamber. The ventricle becomes engorged with blood and has to enlarge. That’s the meaning of “left ventricular hypertrophy” on your echocardiogram report.

 Your leak isn’t great, and your heart is functioning normally. All of that is good news.

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 You have no symptoms of aortic regurgitation, the aortic valve leak. Symptoms are things like breathlessness when you’re active, awakening from sleep gasping for air and chest pain (angina) that comes on with physical exertion.

 Your doctor has judged this not to be a good time to put you on medicines or to suggest surgical correction of the leak. He will follow you carefully with repeat echocardiograms to see if the leak is getting worse or remaining stationary. You might never require medicine or surgery.

 The booklet on heart valve diseases discusses the more common heart valve problems and their treatment. Readers can obtain a copy by writing: Dr. Donohue — No. 105, Box 536475, Orlando, FL 32853-6475. Enclose a check or money order (no cash) for $4.75 U.S./$6 Can. with the recipient’s printed name and address. Please allow four weeks for delivery.

 DEAR DR. DONOHUE: I have not been diagnosed medically, but I am quite sure I have uterine prolapse.

 It is not noticeable when I have been prone for a time, as an overnight sleep, but it protrudes once I am on my feet for a while. It does not cause any real problems except for the yuck factor. I have had it for about a year. I am 74 and gave birth to three children.

 Is it dangerous to do nothing? — C.B.

 ANSWER: Prolapse is a falling down of the uterus, bladder or rectum — one or all three. If prolapse is not causing loss of urine or pain, then you don’t have to do anything.

 Prolapse, however, seldom gets better on its own. It doesn’t always get worse, either.

 Pelvic muscle exercises — the Kegel exercises — might help. The correct muscles to exercise are the muscles you contract to stop urine flow. Perform 10 contractions in a row and repeat the exercises three times a day. If you have pain when doing this, stop.

 DEAR DR. DONOHUE: I took Fosamax for about three years. Then I had routine bloodwork on a routine physical. My liver function tests were elevated. My doctor sent me for an abdominal ultrasound and more blood tests. He then sent me to a gastroenterologist, who scheduled me for an ultrasound-guided liver biopsy. I had no symptoms and felt fine. The liver biopsy was sent to a pathologist in New York who specializes in liver disease. It was determined that Fosamax was toxic to my liver. My doctor and I reported this to the manufacturer and the Food and Drug Administration. After seven months, my tests returned to normal. If I had not had that routine bloodwork, I might have developed liver failure. Patients who take Fosamax need to know this. — D.P.

 ANSWER: Fosamax is a bisphosphonate, a family of drugs that have been invaluable in treating osteoporosis. Esophagus and stomach irritation, bone, joint and muscle pain, and taste disturbances have been side effects for some people. The most serious side effect is osteonecrosis of the jaw — death of a section of the jawbone. That happens very infrequently, and mostly to those treated with intravenous medicine for cancer that has spread to bone. Liver problems aren’t routinely listed as a side effect. I believe your well-documented story and thank you for telling us.

Dr. Donohue regrets that he is unable to answer individual letters, but he will incorporate them in his column whenever possible. Readers may write him or request an order form of available health newsletters at P.O. Box 536475, Orlando, FL 32853-6475. Readers may also order health newsletters from www.rbmamall.com.

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