Intelligencer Journal (Apr 16, 10:25 AM) DEAR DR. GOTT: In your column concerning the 65-year-old wife who suffered from breathlessness in bed at night and obtained relief from standing or sitting, you answered in a treatise of 320 words that the cause was gravity.
Gravity? No way.
The heart is to blame. It is suspended by tissues in a sac in such a way that allows it to work best in the vertical position. When in a horizontal position, the heart is compressed by other organs in the chest cavity, causing stress. You knew all this but got sidetracked.
DEAR READER: No, I didnt get sidetracked. And, Im sorry to say, I disagree with you completely. Your analysis is way off base.
In the column you read, I discussed congestive heart failure (CHF), a cardiac weakness (at least you were correct on this point) that leads to a fluid accumulation in the lungs. This, in turn, causes difficulty breathing at night (medically known as paroxysmal nocturnal dyspnea) because of are you ready? gravity.
Here is a brief synopsis of what goes on.
A failing heart pumps inefficiently. As a consequence, the body retains excess fluid, sometimes several pints of extra fluid. This fluid leaks out into various tissues, causing congestion and swelling (edema). This is why cardiac patients often have swollen ankles. Because of gravity, the excess fluid is moved to the lowest portion of the body: the feet and ankles.
However, when such a person assumes a supine (lying down) position, the fluid because of a different effect from the gravitational pull tends to leave the lower extremities and pool in the lungs. Therefore, patients with CHF may have difficulty breathing at night, but the discomfort can be lessened if they stand or sit to allow gravity once again to pull fluid out of the lungs and into the lowest part of the body: the feet and ankles.
Patients with CHF also experience other symptoms, such as malaise and exercise intolerance, but, basically, symptoms reflect the effects of gravity on the bodys fluid content.
The situation is not repeat, not related to the tissues around the heart. The heart is not compressed by other organs in the chest cavity. In fact, the heart is basically surrounded by lung tissue that is light, fluffy and full of air until a cardiac patient lies down. Then part of the lungs become literally flooded.
CHF therapy is relatively straightforward: medicine to increase the strength of the heartbeat and to reduce the work of the heart, and most important drugs to stimulate the kidneys to excrete the extra fluid that moves from one part of the body to another, depending on gravity.
Remember that CHF is a symptom, not a disease. Any patient who exhibits exercise intolerance, edema or nocturnal dyspnea should be meticulously tested for the cause of these symptoms. More often than not, the affliction is a consequence of coronary artery blockages, cardiomyopathy (a primary disorder of heart muscle) or hypertension, diseases that need to be treated in parallel with CHF.
To give you related information, I am sending you a copy of my Health Report Coronary Artery Disease. Other readers who would like a copy should send a long, self-addressed, stamped envelope and $2 to Newsletter, P.O. Box 167, Wickliffe, OH 44092. Be sure to mention the title.DeEd
