Doc: There is more than one type of heart failure
Dear Dr. Roach: I am 61, and I ride a bike and paddle a kayak, although not as often as I should. I also weigh more than I should. I come from a family with a long history of heart problems, and recently was diagnosed with mild diastolic dysfunction.
What exactly does this mean? Can it have anything to do with the fact that I am almost always tired? What does this mean, long term, for my general health?
Dear S.C.: There are two phases to the cardiac cycle: systole and diastole. In systole, the chamber is contracting; in diastole, the chamber is filling.
Heart failure used to be thought of as primarily a condition of systolic problems, that the left ventricle is unable to pump out all the blood the body needs. However, we are increasingly realizing that some people can have perfectly normal systolic function, but still have symptoms of heart failure, especially fatigue and shortness of breath and especially on exertion. This is now referred to as heart failure with preserved ejection fraction (HFpEF, pronounced “heff-peff”), which sounds like what you may be experiencing.
Diastolic dysfunction can come from high blood pressure, sleep apnea, weighing too much, kidney disease and from rare causes, like amyloid (a condition of abnormal protein deposition).
People with this condition do have an increased risk of death from heart disease, although it is not as bad as the more well-known heart failure with reduced ejection fraction. Treatment is careful control of any underlying issues (especially blood pressure), and often includes other medications, such as spironolactone. This is a situation where it is worthwhile to find an experienced provider, often a cardiologist.
Dear Dr. Roach: I had surgery for a fracture and had metal plates put in to stabilize the bones. I am wondering about metal detectors at airports.
Dear C.M.: Metal detectors at airports are quite sensitive, and people with large amounts of metal, such as an artificial joint or large metal plates, may set off the alarm. In a recent survey, less than half of people with metal implants are detected, and most of those who are said they are not significantly inconvenienced by the process. Having a TSA card or postoperative clearance letter from your surgeon can reduce the risk of problems, but the airport security personnel are used to seeing these now.
Dear Abby: I am planning my wedding. It is making me more anxious than I expected. My fiance and I live together and already have many of the items a newly married couple would usually get as gifts. What is the best way to ask for monetary gifts instead?
Anxious Bride in Virginia
Dear Anxious Bride: While traditionally it is not acceptable to blatantly ask for money — and CERTAINLY not on a wedding invitation — some couples open a bank account to be used for a down payment on a house or a special honeymoon “in lieu of gifts.” The information can be conveyed verbally or on your wedding website.
Email questions to ToYourGoodHealth@med.cornell.edu.