DEAR DR. DONOHUE: You disappoint me beyond belief. I have sent the same letter four times and still can’t get a response. My problem is heart failure. My condition is apparently deteriorating, as my most recent echocardiogram showed an ejection fraction of 20. A year and a half ago, it was 30. In addition to the questions in my first letter, is alcohol a factor? Specifically, are two to three glasses of red wine a week permissible, or is it totally off the menu? Attached is the copy of my original letter. — D.G.

ANSWER: If you were mad before, your wrath is going to hit new heights when you learn that your attached letter did not make it to me. It got lost somewhere en route, but I think I can handle most of what your questions must be.

Ejection fraction is the amount of blood pumped out (ejected) from the heart with each beat. A normal ejection fraction is 55 percent to 78 percent. A low ejection fraction indicates heart failure. Yours is low. You’re not complaining of symptoms like shortness of breath, breathlessness upon lying down or swelling of the ankles and legs, so your heart failure must be compensated for by the medicines you take.

Every year in the United States, a million or more people are admitted to the hospital for heart failure (also called congestive heart failure). Its causes are many. A previous heart attack, heart valve malfunctions, uncontrolled high blood pressure, obstructed blood flow to the heart muscle and inherited heart conditions are a few causes. Most heart failure patients need a combination of medicines to get their hearts pumping more strongly. A diuretic (water pill), an ACE inhibitor and a beta blocker are three drugs most often chosen. The water pill removes excess fluid that accumulates in heart failure. For the same reason, salt restriction frequently is prescribed. The other two drugs make it easier for the heart to pump.

Some people require cardiac resynchronization, a pacemaker that gets the two heart-pumping chambers – the ventricles – back into synchrony with each other in order to increase pumping effectiveness.

Heavy alcohol drinking is bad for you. Your drinking is nowhere near “heavy.” You can continue with your wine.

The booklet on heart failure explains this condition in detail. To obtain a copy, write: Dr. Donohue – No. 103, 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: Exactly what is prickly heat? Do adults get it? If they do, I think I have it. — M.K.

ANSWER: Adults do get prickly heat. It looks like red dots or tiny blisters on the skin. The rash itches or feels “prickly.” Sweat ducts have become plugged.

Prevention comes with dressing as coolly as possible in light cotton clothes. Air-conditioning is the ultimate answer. Second best is having a fan blowing on you. If you have a breakout, cool-water compresses take away the itch or prickliness, as do cortisone creams, which are found in all drugstores.

DEAR DR. DONOHUE: I am an 81-year-old retired physician. I have tried to find information on corn syrup. When I was a child, my family bought Karo corn syrup in pails, which was all we could afford. I have tried to find the difference between that and the high fructose corn syrup we hear about today. Is it the same? — F.C., M.D.

ANSWER: Karo syrup is a mixture of dextrose (glucose) and other sugars derived from cornstarch. There was always a bottle of it in our house, too. It’s still sold today.

High fructose corn syrup is obtained through a commercial process that converts glucose into fructose (fruit sugar). This product is then mixed with pure corn syrup and used as a sweetener in many commercial products and soft drinks. It is cheaper than regular sugar.

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.