DRHOOK- Gasp! CHF takes your breath away

the handsome doctor John Hong of Charlottesville

In the movie Beaches, Bette Midler was with Barbara Hershey to the end. Barb was lying on a chaise-lounge on the beach wearing an oxygen mask, because she was dying of congestive heart failure from cardiomyopathy (enlarged, weakened heart). 

The audience heard Bette singing "Wind beneath My Wing," and I'm sorry, but I cry every single time I see that scene! Water fountains burst from my eyes, and I can hardly breathe. I'm worse than Tammy Faye Baker.

But you know what? That's how I want to die. I want to be a famous national columnist, on the beach typing my last article on my laptop. Just before I take my last breath, I will hit "send" to my editor, and then Bette Midler will croon out, "A beautiful smile to hide the pain!"

Will I die of congestive heart failure (CHF)?

My grandmother died of CHF around the age of 71. I was in college at the time, and I didn't understand what CHF was. I just knew she had a weak heart and got out of breath easily.

In CHF, the body– whether from a diseased heart, fluid overload, or because illness requires more energy than the heart can provide– doesn't get enough blood and oxygen. Since heart disease is the #1 killer in this country, CHF is usually due to a sick heart—from damaged muscles due to a heart attack, an enlarged heart, a heart valve problem, an arrhythmia that doesn't let the heart pump properly, or pericardial disease (where the outside lining constricts the heart).

Enlargement of the heart usually occurs in the left ventricle– the main chamber that pumps blood out to the body. High blood pressure forces the left ventricle to work harder, and– just like Arnold Schwarzenegger's arms– the heart muscle gets big as a result. You would think a thick, strong heart muscle would be stronger, but it isn't. It can't relax enough to fill up its chamber with blood, and also the extra thickness can cause a deadly arrhythmia.

The lungs often fill up with fluids from this backlog of blood, since the heart can't pump things out fast enough. This leads to shortness of breath— and a sensation like drowning.  

When it's mild, CHF will prevent a person from doing activities that weren't hard before, like running up a hill or chasing his spouse up the stairs to make whoopee. When moderate, CHF makes plain old everyday exertion difficult, like shopping for groceries or walking the dog.  Severe CHF is miserable because a person has to stop walking to catch a breath just to walk across the room.  

The worst case scenario is when a person is short of breath from doing nothing, like sitting in a chair.

Lying down can make it more difficult to breathe, because gravity no longer pushes the fluids down to the legs, and it goes up to the lungs. So folks can wake up in a panic and stand up to race to the window for air. I know some folks who have to sleep on three or four pillows or upright in a Lazy-Boy chair to breathe. With enough fluids building up, the legs become swollen (edema), and the abdomen can as well.

Treatment usually requires good diuresis (peeing the fluids out), fluids restriction, and heart medications to pump blood better. A cardiologist will also see what needs to be done to treat the underlying problem.

Okay, now I've decided I really don't want to die from shortness of breath. Maybe I can just drift away on the beach after writing my last article, "Life's a Beach, and Then You Die."

Dr. Hook cracks a joke or two, but he's a renowned physician with a local practice. Email him with your questions.