DEAR DR. DONOHUE: What’s the difference between heart failure and cardiomyopathy? About six years ago, I had an ejection fraction of 26 percent. I was extremely short of breath. I was told I had heart failure and would have to take medicine. The medical records I saw said I had cardiomyopathy.

My last echocardiogram showed an ejection fraction of 77 percent. My cardiologist said only a very few ever recover like I did. Will I continue to take medicine forever? – B.S.

ANSWER: The meaning of heart failure (also called congestive heart failure) is that the heart has become such a poor and weakened pump that it cannot support the body’s needs for oxygenated blood. It makes people very short-winded. Fatigue, ankle swelling and wakening from sleep to gasp for breath are other signs of heart failure. The most common but not the only cause of heart failure is clogged heart arteries. The ejection fraction is the amount of blood emptied from the heart with each heartbeat. A normal ejection fraction is greater than 50 percent. A value of 26 percent indicates serious heart failure.

Cardiomyopathy (CAR-dee-oh-my-OP-uh-thee) is heart muscle disease not due to clogged heart arteries, heart valve disease or high blood pressure – something has directly attacked the heart muscle. One kind of cardiomyopathy that fits your story is a viral infection of heart muscle. I say that because of the miraculous turnabout in your heart muscle function. It’s gone from very bad to stupendous. Not all cardiomyopathies end on such a happy note.

Only your doctor can tell you if you have to continue with heart medicine.

DEAR DR. DONOHUE: How long must women have mammograms? I am 80 years old. I had one yesterday and was hesitant to ask, as the office was very quiet with no one else waiting. That made me believe that they were not doing so well so they would tell me I have to have them forever to keep business going. – M.R.

ANSWER: No established upper age limit has been set by all expert groups for stopping mammograms. The American Cancer Society states that “as long as a woman is in reasonably good health and would be a candidate for treatment (of breast cancer), she should be screened with mammograms.”

In the United Kingdom, Canada and Australia, once a woman reaches 70 (or 75, in some places), she is not pushed to have a mammogram, but is still eligible to be screened with one if she wishes.

The breast cancer story is told in detail in the booklet on that subject. Readers who would like a copy can obtain one by writing: Dr. Donohue – No. 1101, 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: My husband had surgery for a hydrocele. What caused it? – J.M.

ANSWER: A hydrocele (HI-drowe-seal) is a collection of clear fluid within the testicle. Fluid can drip from the abdominal cavity into the testicle to form a hydrocele. Or, one can form after an infection or after trauma to the testicle. Quite often, one develops without any reason being discovered.

If the swelling is large or if it causes any discomfort, it can be removed easily. In a few rare instances, hydroceles are associated with testicular cancer. An ultrasound examination of the testicle detects such a cause if there is a suspicion for cancer.

DEAR DR. DONOHUE: A commercial I saw on TV had a grandparent and grandchild talking about peripheral artery disease. It got me wondering if I have it. I got the idea that many older people do. I am 78. What are its signs? – K.M.

ANSWER: Peripheral artery disease, PAD, also goes by the name peripheral vascular disease. It is a common condition in older people, but not every senior citizen has it. Close to 15 percent of those over 70 do.

Here “peripheral” refers to the legs. “Artery disease” is artery clogging, the same process that goes on in heart arteries and culminates in a heart attack. High blood cholesterol, blood fats, blood protein and platelets aggregate on an artery wall and, as the buildup grows, it blocks circulation to the tissues fed by that artery.

Blood doesn’t reach leg muscles in a sufficient amount to support those muscles when they’re active. The common sign of PAD is calf pain while walking. The pain leaves when the person stops walking. Many people with PAD can tell, almost to the inch, when the pain will begin. The pain indicates leg muscles aren’t getting enough blood.

A simple office test to detect PAD is to compare blood pressure taken at the ankles with blood pressure taken in the arms. The two readings should be close. With PAD, the ankle blood pressure is lower than arm pressure due to the obstruction to blood flow.

Management of PAD is similar to management of clogged heart arteries. Blood cholesterol has to be lowered, blood pressure normalized and blood sugar controlled. Weight reduction, if indicated, is important and daily exercise, – even though pain occurs during walking – has to become routine. Cigarette smoking, of course, is out of the question. If the doctor does confirm a diagnosis of PAD, prescription medicines help blood get around artery blockages.

Aspirin, Plavix and Pletal are examples of such medicines. When the obstruction is sizable, then leg arteries can undergo the same kinds of treatments as heart arteries – bypass surgery or stents.

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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