DEAR DR. DONOHUE: I am a 31-year-old woman and have been athletic all my life. About three months ago, I started having fainting spells. I have had three in all. I saw my family doctor, and after many tests and many referrals I was found to have an enlarged heart and cardiomyopathy. What can I expect? – B.J.

ANSWER: The cardiomyopathy is the reason for your large heart. For our purposes, consider cardiomyopathy as being a heart (“cardio”) muscle (“myo”) disease (“pathy”) that is not due to clogged heart arteries or deformed heart valves – two common causes of heart problems. An important variety of cardiomyopathy, and the kind I believe you have, is called hypertrophic cardiomyopathy, and it is a genetically caused heart illness.

In this condition, heart muscle fibers enlarge (hypertrophy) and are arranged haphazardly, not in the usual neat array. One result of this is an encroachment of heart muscle on the left ventricle. It is the pumping chamber that receives oxygenated blood and pumps it out into the body. Due to the bulging muscle, the ventricle cannot hold its normal volume of blood. The brain is shortchanged, and that can lead to fainting. Furthermore, the haphazard array of muscle fibers often incites peculiar and dangerous heartbeats, another cause of fainting. Other symptoms of cardiomyopathy include a desperate struggle for air when active and the onset of chest pain much like the chest pain of angina.

You can expect more tests, and you can also expect treatment. Often, initial therapy is with beta blocker drugs. Those medicines relax the heart muscle and permit it to hold a greater volume of blood. Furthermore, they are useful in preventing abnormal and dangerous heartbeats.

There are other medicines that can be used, and there are ways to directly attack the problem by surgically removing the excess muscle or by causing some of it to shed through an injection of alcohol into a selected heart artery.

Hypertrophic cardiomyopathy is a cause of sudden death in young athletes. Your sisters, brothers and children should all be screened for this disorder.

DEAR DR. DONOHUE: What makes a heart attack a “massive” heart attack? My uncle just died from a heart attack, and we are told it was a massive one. Isn’t every heart attack massive? – K.L.

ANSWER: All heart attacks entail the death of heart muscle, usually from a block in a heart artery that services a particular section of heart muscle.

A massive heart attack is one where a huge segment of heart muscle dies because the obstruction occurs in a major heart artery. Massive heart attacks often leave the heart so weakened that it cannot pump blood. Death is the outcome of many massive heart attacks.

Not all heart attacks are massive. Some can be so slight that the person never knows he or she had an attack. Frequently, an electrocardiogram shows the damage. The doctor surprises a patient by telling him or her that the ECG shows an old heart attack.

Heart attacks are the No. 1 cause of death for both men and women. Readers who would like a insight into their cause and treatment can obtain the heart attack pamphlet by writing: Dr. Donohue – No. 102, Box 536475, Orlando, FL 32853-6475. Enclose a check or money order (no cash) for $4.50 U.S./$6.50 Can. with the recipient’s printed name and address. Please allow four weeks for delivery.

DEAR DR. DONOHUE: I have a question about mad cow disease that I would like you to answer. Heat does not kill the mad cow disease germ, right? Why then are we told to order hamburgers well-done? I happen to like mine rare. – W.W.

ANSWER: Prions, the cause of mad cow disease, have been only recently discovered. They are odd kinds of germs and are not destroyed by ordinary cooking temperatures. Mad cow disease is not the reason for advising hamburgers (and all meat) to be well-done. That warning is to prevent spread of the common food-poisoning germs, such as E. coli and salmonella.

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.