DEAR DR. DONOHUE: About two months ago, my daughter was diagnosed with vasovagal syncope. Prior to that, she had experienced nausea, sweats, fatigue and a feeling as if she were going to faint. These symptoms appeared three months after the birth of her daughter and have been continuous for the past nine months. She walks 3 miles a day and drinks plenty of fluids. I wonder if there is any treatment for a young mother, age 23. – M.M.

ANSWER: Syncope is a faint. Vasovagal syncope – also called neurocardiogenic syncope – is one of the most common kinds of faints, the ones that happen in overheated rooms, on standing in one position for a long time, in situations of great anxiety and in numerous other circumstances. It’s the kind of faint that can happen to young, healthy, athletic people with no signs of any serious illness.

Often such faints are preceded by warning signs – nausea, waves of warmth, sweating, pallor and lightheadedness. Blood vessels dilate (the “vaso” of “vasovagal”), and that brings a drop in blood pressure. Nerve signals to the heart slow it (the “vagal” of “vasovagal”) – just what you don’t want when blood pressure drops. Circulation to the brain greatly diminishes, and the person slumps to the ground. In that position, circulation picks up, the brain receives blood and the person wakes.

I don’t know if your daughter’s delivery contributed to these symptoms. They can happen without a cause.

If she feels a faint coming on, she should sit with her head between her legs or, even better, lie down. Making strong, sustained muscle contractions keeps blood circulating. By locking the fingertips of her hands together and then pulling the arms forcefully in the opposite directions, she can abort an attack.

Medicines like fludrocortisone maintain circulation. Other medicines are available too. One thing bothers me about her story: You say she has continuous symptoms. If that’s true, the diagnosis is questionable. I would have her get a second opinion.

DEAR DR. DONOHUE: I had what I took to be a stomach infection. After it left, I still had stomach pain and shortness of breath. I got many different diagnoses, but the emergency doctors said I had congestive heart failure with hepatic congestion – cardiac hepatitis. What is this? Can I control it? — R.M.

ANSWER: Congestive heart failure is a heart that pumps so poorly it cannot completely empty itself of blood. Blood backs up in many tissues and organs. Fluid from the backed-up blood leaks out and floods (congests) those organs and tissues. In the lung, the fluid (the congestion) blocks the entry of oxygen into the body. That caused your shortness of breath. In the liver, it impairs that organ’s many functions, causes it to swell and leads to abdominal pain.

You can control it by getting the heart to pump more forcefully. A strongly beating heart relieves tissue and organ congestion. Medicines strengthen the heart. You have to go easy with salt to discourage fluid retention.

Congestive heart failure is a common condition. The booklet on it describes its symptoms and treatments. To order a copy, write to: 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: A group of us had a heated discussion on the best time to take cholesterol pills. All of us, except for one, take the pill at bedtime. I called several pharmacists, who said to take it at bedtime. What do you say? – J.L.

ANSWER: You’re speaking of the statin drugs, correct? Those drugs slow the liver’s production of cholesterol, and most of that production takes place during the night. Statin drugs that stay a relatively short time in the blood are taken before going to bed to stop the liver’s nighttime cholesterol output – Mevacor, Zocor and Lescol. Statin drugs that stick around for a long time can be taken at any time of day – Lipitor, Crestor and Pravachol.

DEAR DR. DONOHUE: I am a 53-year-old male. I work out three times a week. I take Tenormin once a day. How do I judge my cardiovascular workout, since the Tenormin doesn’t allow my heart rate to increase much? – B.

ANSWER: Beta-blocker drugs like Tenormin slow the heartbeat. You can’t use heartbeat as a gauge of exercise intensity. You have to use your own estimation of how hard you are exercising. Even though you can’t raise your heart rate to a predetermined level, you are getting all the exercise you need, and your heart still benefits from it.

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