DEAR DR. DONOHUE: I have been diagnosed with congestive heart failure. My heart is working at only 30 percent of its capacity. Can you explain what all this means? – D.P.

ANSWER: Congestive heart failure results when the heart beats too weakly or when it is unable to sufficiently expand to accept the volume of blood that returns to it. In either case, blood backs up into the lungs – it “congests” them.

Congested lungs make people breathless. Making a bed leaves them panting. Often, lying flat causes people with congestive heart failure to gasp for air. Frequently it wakens affected people during the night, struggling to catch their breath.

Other body tissues become congested, and that can often be seen as swollen ankles.

With each beat, a normal heart pumps out at least 50 percent of the blood it contains. Yours is pumping out only 30 percent. That is evidence of congestive heart failure.

Its causes? Poor blood circulation to the heart muscle, untreated high blood pressure, a previous heart attack and defective heart valves are some of the things that lead to heart failure.

The situation is not hopeless. Medicines can get the heart contracting more forcibly. In times past, digitalis drugs and water tablets (diuretics) were the only medicines for heart failure. They still are used, but now there are many more. ACE inhibitors and beta blockers are two newer additions. The names are not important. I mention these two only to show that there is a good stock of medicine treatments for your problem.

Pacemakers are finding a way into heart-failure therapy. Often the two pumping heart chambers, the ventricles, are out of step, and that contributes to heart failure. For some people, bringing them back into sync can promote more forceful heart action – a brand-new solution to congestive heart failure.

The heart-failure pamphlet discusses this problem in depth. To obtain a copy, write to: Dr. Donohue – No. 103, 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: My sister died this past year of liver cirrhosis. It was not alcohol-related. Since then, my other sister discovered she is a carrier of hemochromatosis. In her mind, hemochromatosis might have caused my first sister’s death. I have been tested, and I do not have the disease, but I am a carrier. I am in my 60s. Is it possible that I might still get the disease? – G.H.

ANSWER: Hemochromatosis (HE-moe-CROW-muh-TOE-suss) is a common genetic illness that suffers from poor public recognition because of its unpronounceable name and lack of publicity. Many people carry one gene. Those people don’t come down with the illness. It takes two genes, one from the mother and one from the father, to produce disease.

Two hemochromatosis genes cause the body to lose its ability to regulate how much iron it absorbs. Too much gets into the blood and eventually into many organs. Excessive iron in the liver leads to liver scarring – cirrhosis. In the pancreas, it causes diabetes, since the pancreas is the site of insulin production. Iron in the skin gives rise to a bronze discoloration. Iron in heart muscle can cause heart failure. Iron-loaded joints suffer from arthritis.

All relatives of a person with hemochromatosis need testing. When the illness is discovered early on in life, before organ damage has occurred, periodic removal of blood prevents damage from happening. Blood is body’s largest depository of iron.

With only one gene, you are not going to come down with this illness.

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.