Continue to consult with physician

Dear Dr. Gott: I am 47, female, with a weak heart, despite the fact that I exercise regularly, avoid alcohol and cigarettes, am not overweight and consume a low-fat diet.

The problem began in February when I discussed my chest discomfort with my physician. He examined me, ordered a chest X-ray, an EKG, a blood cholesterol and a stress test – all normal. I also had a cardiac ultrasound that showed a weak ejection fraction of 60 percent, which he claims proves that my heart is beating inefficiently.

Subsequently, I saw a cardiologist who confirmed that I passed the stress test with flying colors. He said that if my heart is weak, the degree of weakness is not “clinically significant.”

Despite this conclusion, the cardiologist gave me two medicines for high blood pressure and one drug for high cholesterol. I do not understand what my doctors are saying. Can you translate?

Dear Reader: I’ll try.

The term “weak heart” ordinarily refers to a weakness and inefficiency of the cardiac contractions; in short, the pump isn’t pumping as effectively as it should.

Frankly, I don’t see any evidence that this is the case in your situation. The ultrasound test showed a 60 percent ejection fraction, which is well within the normal range for healthy adults. In addition, you passed your stress test.

At this point, based on the information you supplied, I would conclude that your heart is normal, and the doctors should look for other, noncardiac causes of chest pain. This can be a diagnostic challenge because there are many conditions that can cause this symptom. In your case, the heart is not one.

Should you choose to investigate your cardiac function more aggressively, return to your primary care physician for advice and referral for a coronary angiogram – an X-ray study of the circulation to your heart muscle.

Finally, the medications.

I don’t want to second-guess your physicians, but medication may not be in order here, if your blood pressure and cholesterol level are normal. (Of course, if they’re not, your doctors are completely correct.)

Once again, I urge you to discuss this aspect of your care with your family physician. Or, if you wish for an alternative, consider a second (or third) opinion from another cardiologist.

My gut reaction is that your heart is normal and you may not need expensive prescription drugs. But, without a doubt, work with your primary care physician to resolve this confusion.

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.