"Ask the Doctor": Heart Failure

February 15, 2000

Dr. Coulter of the Texas Heart Institute at St. Luke's Episcopal Hospital, Texas, answers audience health questions.

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HoustonChronicle: Welcome to Ask the Doctor! The purpose of the Ask The Doctor chats are to provide general information and is in no way intended to be construed as medical advice for any visitors' specific disease or condition. The intent is to increase a participants' knowledge about a general disease or condition. For treatment of your specific condition please see your personal physician. This forum is not intended to be used in emergency situations. If you are uncertain of the urgency of your problem or condition, contact your personal physician or the nearest hospital for assistance. HoustonChronicle.com, St. Luke's Episcopal Hospital - Houston and the Talk City Network are proud to present our special guest for today, Dr. Coulter of the Texas Heart Institute at St. Luke's Episcopal Hospital. Welcome Dr. Coulter!

Dr Coulter: Thanks for having me!

Mimi: What is Heart Failure?

Dr Coulter: Heart failure is kind of a generic word for symptoms of pulmonary congestion. This can be related to either the systolic function or diastolic function of the heart. Systolic is the squeezing phase, and diastolic is the resting phase. Either can cause symptoms of pulmonary congestion.

GravityOfLove: How do you diagnose Heart failure? Is there a specific age range I am more prone to have this happen to me?

Dr Coulter: Diagnosis of heart failure is made from the clinical symptoms and a physical examination. Heart failure can occur at any age, and the age helps to dictate what the etiology is. It's really just a symptom of a problem. It can occur in the newborn period, for babies whose hearts are malformed. But of course, in general, the risk of heart failure increases with age. The most common causes of heart failure in an adult are a history of heart attack, valvular abnormalities, and what we call cardiomyopathy, caused by a virus, which causes a weakening of the heart function. Then there's a whole list of more obscure causes, including iron overload, Vitamin B deficiency, etc. (These are very unusual!) The vitamin deficiency heart failure often occurs in alcoholics.

Raccoon: My father died of a heart attack at 69, my brother at 48 and my mother at 75, all were overweight and smoked. I'm not overweight and have never smoked; are my chances of heart disease really high?

Dr Coulter: We know of multiple cardiac risk factors. Smoking is a very strong risk factor, especially in women. So it is important to avoid smoking to avoid the development of early coronary disease. However, a strong family history is probably the most important risk factor that we know of. The genetics dictate how we handle and process cholesterol. Therefore, I would advise that you not smoke, that you get your cholesterol checked, that you monitor your blood pressure to treat hypertension, or high blood pressure, and that you check to see if you have diabetes, which is also strongly related to your genetic inheritance. In women, the traditional risk factors apply similarly, as have been shown for men with one caveat - that is, the good cholesterol, or HDL, is extremely predictive in women. You are at risk when your HDL levels are low. One thing that increases your HDL levels is exercise, so a good exercise program may be valuable.

Visitor: Is Vitamin E really that important to maintaining a healthy heart? What about other vitamins?

Dr Coulter: A very large study recently (within 3 weeks ago!) called the Hope Study, released results of 12,000 patients where some patients got Vitamin E, and some did not. They followed the patients for 3 years, and followed the incidence of coronary events and there was absolutely no benefit to using the Vitamin E. Although some small studies had given us reason to believe that Vitamin E would be beneficial for heart disease patients, the data does not confirm that. The great thing about it is it that it's not harmful. On the other hand, it's not that beneficial either. The only vitamin that you absolutely have to have for a healthy heart is thiamine, and in patients with alcoholism, where food intake is diminished, they can have a reduced cardiac function from that vitamin deficiency, which is immediately reversible with the injection of intravenous thiamine. To my knowledge, Vitamin C has not been studied in a big population, but Vitamin C is important for capillary repair. In fact, severe deficiency of Vitamin C leads to scurvy, which is characterized by poor wound healing. But I don't think excess Vitamin C will be beneficial to the heart.

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