DEAR DR. DONOHUE: What’s the meaning of “enlarged heart”? I have a copy of my chest X-ray report, and it says I have one. What are the health implications of this? – R.M.

ANSWER: My answers are beginning to sound like a broken record, but you must know the cause of the heart enlargement before you make a statement about its significance.

Hearts can grow bigger for good reasons. The heart is a muscle, and like all muscles, its size increases with exercise. Athletes have larger hearts than nonathletes. Their hearts can pump more blood with each beat than can the hearts of untrained people. That’s a plus.

Hearts also enlarge for bad reasons. High blood pressure makes the heart pump against an unnaturally high resistance. That stimulates heart growth. Up to a point, that’s good. But if the high blood pressure isn’t relieved, the large heart will tire out and become a poor pump.

With heart failure, the chest X-ray shows a large heart. In this condition, the heart is a flabby bag. It can’t empty its blood into the aorta and the rest of the body. The overfilled heart stretches out of shape. Medicines can relieve the heart congestion and can often shrink the heart.

Heart valve problems can also lead to a bigger heart, sometimes for the same reason high blood pressure does. A narrowed heart valve, for example, makes the heart pump with unnaturally greater force, and it cannot sustain that effort year in and year out.

There are some inherited heart diseases that also lead to heart enlargement.

You must see a doctor. Who ordered the chest X-ray? Give that person a call and ask for an appointment. You have to get to the bottom of this.

The booklet on congestive heart failure describes one of the greatest causes for an enlarged heart. Readers can order a copy by writing: Dr. Donohue – No. 103, Box 536475, Orlando, FL 32853-6475. Enclose a check or money order (no cash) for $4.75 U.S./$6.75 Can. with the recipient’s printed name and address. Please allow four weeks for delivery.

DEAR DR. DONOHUE: For more than a year, I have suffered from torticollis. My doctor says I have to learn to live with it, since there’s nothing to do for it. Isn’t there any medicine I can take? – R.B.

ANSWER: Your doctor is wrong. You need to see a neurologist. There are medicines and surgical procedures for your condition.

Torticollis (TORE-tuh-CALL-us) belongs to the dystonia family of illnesses. Dystonias feature sustained, involuntary contractions of muscles that put the body into contorted and often painful postures. In this case, neck muscles on one side contract and bring the head toward one shoulder, or bend it forward or backward and keep it locked in that awkward position.

Medicines can be prescribed to relax the contracted muscles. Botox injections are another valuable treatment. They cause the contracted muscles to go limp. In some cases, surgical procedures are used to return the head to its normal position.

DEAR DR. DONOHUE: My chest X-ray shows that I have had an old fungus infection. I never remember being ill for a day in my life. What are they talking about? I am quite active. I run 20 miles a week. Please explain this unsettling comment for me. – J.A.

ANSWER: A number of fungi can invade the lung. They often do so without the invaded person showing any signs of illness. The names of some of these fungi are Histoplasma, Coccidiodes and Blastomyces. Don’t worry about pronouncing the names.

Flecks of calcium are probably scattered throughout your lungs and were seen on your chest X-ray. The body has entombed the fungi in calcium coffins.

If you haven’t had any symptoms in the past, you’re not likely to have symptoms in the future. Your personal physician can clear the air for you.

DEAR DR. DONOHUE: We had a water softener installed in our new home. It uses rock salt for the softening process. My wife is concerned that the salt used in the softener is increasing her sodium consumption. She drinks a lot of water.

Could you offer some advice on this subject? – R.G.

ANSWER: Water softeners take hard minerals like calcium and magnesium out of water and replace them with soft minerals like sodium chloride – salt. Hard minerals prevent soaps from foaming and leave rings around tubs and sinks.

If water is quite hard, a softener adds about 80 mg to 150 mg of salt to each quart of water. Such an amount of salt doesn’t raise the blood pressure of or cause heart troubles in healthy people. Only if a person is on a very strict low-salt regimen would this be of any consequence.

The booklet on sodium, potassium and other minerals doesn’t deal with water softeners, but it does explain these minerals, a source of concern to many. Readers can order a copy by writing: Dr. Donohue – No. 202, Box 536475, Orlando, FL 32853-6475. Enclose a check or money order (no cash) for $4.75 U.S./$6.75 Can. with the recipient’s printed name and address. Please allow four weeks for delivery.

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