DEAR DR. DONOHUE: I am a 48-year-old woman. I had rheumatic fever when I was 9 and had a mild heart murmur for less than a year. I have been on prophylactic penicillin daily since that time. In spite of eating well, having normal cholesterol levels and no family history of heart disease, last year I was discovered to have a blockage of my left anterior descending heart artery and had a stent placed. My cardiologist feels that penicillin is not necessary and advises me to discontinue it. I would appreciate your thoughts. — L.H.
ANSWER: For a relatively small number of people, a strep (the Streptococcus bacterium) throat is followed by rheumatic fever. Rheumatic fever consists of heart inflammation; possible heart-valve damage; swollen, painful joints; a skin rash; lumps under the skin; and jerky movements of the hands and legs. Not all these signs are present in every case of rheumatic fever. The most serious complication is heart involvement.
Once a person has had rheumatic fever, that person is quite susceptible to another attack of it. To prevent a second attack and further damage to the heart, people who suffered one rheumatic fever attack are put on a program of penicillin prophylaxis. “Prophylaxis” means “protection” or “prevention.” The American Heart Association has updated its guidelines for this prophylaxis: Anyone who has had heart inflammation and heart-valve damage should continue penicillin prophylaxis for 10 years or until age 40, whichever is longer. Those who had heart inflammation without valve damage (this is where you fit in) require prophylaxis for 10 years or until age 21, whichever is longer.
You don’t need to take penicillin any longer. People who had other signs of rheumatic fever but no heart involvement stay on prophylaxis for five years or until age 21, whichever is longer. Rheumatic fever didn’t cause your current heart artery blockage. It’s hard to say why a young woman with normal cholesterol and no other risks for heart artery disease developed such a blockage.
DEAR DR. DONOHUE: I have been taking Zocor and Lopid for the past 15 years. As a result I contracted rhabdomyolysis. I spent five days in the hospital. Now that my muscle enzyme levels have come down, I was told not to take any statin drugs again. What can I take to keep my cholesterol from skyrocketing? — L.G.
ANSWER: Rhabdomyolysis (RAB-doe-my-OL-uh-siss) — destruction of muscle tissue — is a rare complication of statin treatment. Zocor is one of the statin drugs. The statins are the most powerful agents for cholesterol-lowering. Have you tried a low-fat, low-cholesterol diet as a way of reducing your cholesterol? It’s a diet of mostly fruits, vegetables and whole grains with little meat and some fish. Low-fat dairy products are permitted. Daily exercise keeps cholesterol down. If your cholesterol doesn’t come under control with such a program, then you can get a helping hand from niacin, Welchol, Cholestid or Zetia, medicines that work differently from statins.
DEAR DR. DONOHUE: My husband, 76, is a dedicated runner and in excellent condition. We monitor our blood pressure at home. His systolic pressure ranges from the 120s to 160, usually 130 to 140. His diastolic pressure never goes above 70. Will you comment on this unusual pattern? — S.S.
ANSWER: Normal blood pressure is below 120/80. High blood pressure, hypertension, is 140/90 and above. Your husband’s diastolic pressure of 70 is wonderful. A consistent systolic pressure of 160 isn’t so hot. At older ages, systolic pressure rises. Your husband’s occasional reading of 160 reflects age-related changes in arteries. Since this is only an occasional and not a persistent reading, he’s doing OK. His running program has helped him.
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.
Send questions/comments to the editors.
Success. Please wait for the page to reload. If the page does not reload within 5 seconds, please refresh the page.
Enter your email and password to access comments.
Hi, to comment on stories you must . This profile is in addition to your subscription and website login.
Already have a commenting profile? .
Invalid username/password.
Please check your email to confirm and complete your registration.
Only subscribers are eligible to post comments. Please subscribe or login first for digital access. Here’s why.
Use the form below to reset your password. When you've submitted your account email, we will send an email with a reset code.