DEAR DR. DONOHUE: My husband died of a heart attack at age 42. I cannot stop blaming myself for what happened. He said he felt very tired, and he went to sleep in a recliner chair. I went to wake him for dinner, but he did not respond. He had died. I can’t forgive myself for letting this happen. How could I have known he was having a heart attack? – R.R.

ANSWER: You couldn’t have known. Highly trained medical personnel might not have recognized what was happening. Your husband’s death was a tragedy that was not preventable. You have my condolences.

Vague, nonspecific symptoms can herald a heart attack. A doctor friend recounted his heart attack symptoms to me. He was sitting at his desk and found he couldn’t keep his head up because he was so weary. He had to rest it on the desk. He had no pain at all. For at least half an hour he didn’t realize what was happening, and he was trained in these matters. How could you be responsible for not recognizing symptoms that a doctor did not recognize in himself?

The overwhelming fatigue that a heart attack can usher in comes from the sudden decrease in the heart’s pumping action. There’s a drop-off in circulating blood that saps a person’s energy. Other so-called atypical heart attack symptoms include dizziness, breaking out in a cold, drenching sweat, or an attack of nausea and vomiting. The sudden onset of breathlessness is another tip that a heart attack could be occurring.

If a person experiences these symptoms without chest pain and has reason to believe they might be heart attack symptoms, then a 911 call should be made, and that person, if there are no contraindications, should chew a full-strength, 325-mg aspirin.

The heart attack booklet discusses all aspects of heart attacks. Readers can obtain a copy by writing: Dr. Donohue – No. 102, Box 536475, Orlando, FL 32853-6475. Enclose a check or money order (no cash) for $4.50 U.S./$6.50 Can. with the recipient’s printed name and address. Please allow four weeks for delivery.

DEAR DR. DONOHUE: Will you bring us up-to-date on tarsal tunnel syndrome – what it is and how it’s treated? – F.R.

ANSWER: Tarsal tunnel syndrome is the ankle-foot equivalent of the wrist-hand carpal tunnel syndrome. The problem is pressure on a nerve in the ankle as it passes into the foot. It enters the foot by traversing a bone-and-ligament tunnel. Anything that narrows the tunnel – inflammation, for example – compresses the nerve and leads to symptoms.

People with the syndrome complain of numbness, tingling, burning or other painful sensations on the sole of the foot.

Anti-inflammatory medicines such as aspirin or ibuprofen can relieve pain and reduce any inflammation that’s compressing the nerve. Cortisone injections into the tarsal tunnel do the same. An ankle splint rests the ankle and the tarsal tunnel and can relieve nerve compression. If all of these measures fail, then surgically freeing the nerve from whatever has entrapped it usually assures relief.

DEAR DR. DONOHUE: I love orange juice but quit drinking it, thinking it might be causing gout flare-ups. Is that possible? – R.M.

ANSWER: Neither orange juice nor oranges are on any list of foods that precipitate a gout attack. Purine-rich foods – anchovies, organ meats (kidney, liver, sweetbreads), gravies, meats, fish, asparagus, peas, spinach, and mushrooms – might lead to an attack. Purine is a precursor of uric acid, the stuff that infiltrates joints and causes gout. Recent evidence simplifies the gout diet to eating less red meat and seafood and drinking more low-fat dairy products.

Gout sufferers who drink two or more glasses of skim milk a day are half as likely to come down with an attack than are those who don’t do this.

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.