Dear Dr. Roach: After reading several of your columns, where readers asked if they are too old for some activity, I wanted to make older adults aware of their untapped reservoir of energy and ability. I notice that most tend to be hesitant to try various activities thinking they are probably too old to attempt it.
I am a retired music teacher; I am not an athlete. I never participated in sports, and I was the “runt of the litter.” I started weight training when I turned 50 and have continued to experience the ability to lift even heavier loads for the past 20 years. It makes me believe that I still haven’t reached my potential. Also, since I retired, I find that although I do not have the stamina I used to have, I can continue to road bike similar distances as 20 years ago just adding a few minute breaks along the way. When I turned 55, I completed training in taekwondo and earned my black belt. I am convinced that preconceived notions get in the way of our challenging ourselves and realizing our abilities.
I thank A.M. for writing. I often write about the importance of exercise, especially at older ages. I think this letter expresses how much good exercise can do, but I would just add that the sense of confidence and well-being that comes from being more physically fit is very powerful.
Dear Dr. Roach: I have high blood pressure. My most recent echocardiogram said I have a “hyperdynamic left ventricle,” “concentric left ventricular hypertrophy” and “abnormal left ventricle relaxation.” Is this heart failure? My doctor put me on beta blockers. Worrying about my heart gives me sleepless nights. Is it serious?
When high blood pressure isn’t treated rapidly and properly, the heart undergoes changes to try to adapt to its increased workload. The heart muscle thickens (“hypertrophy”) and strengthens, so it can empty more blood (“hyperdynamic”). Unfortunately, there are several costs to these changes. One is that the left ventricle chamber wall can get so thick and stiff it cannot relax properly, which is the third point in the echo report. That translates to higher pressures inside the heart, which are transmitted to the lungs.
Abnormal heart relaxation is found in a type of heart failure called heart failure with preserved ejection fraction (the ejection fraction is the proportion of the blood in the heart that is squeezed out with each beat: It’s normally 50-75%, and yours is at the high end of that, at 72%). The treatment is to get to and keep the blood pressure at a normal level. Some medicines appear to be more effective than others. ACE inhibitors and certain diuretics have shown in some trials to be more beneficial.
However, it’s not clear to me whether you have heart failure, which requires symptoms. The major symptom of heart failure with preserved ejection fraction is shortness of breath, especially with exertion, and fatigue. Ideally, treatment should be begun before symptoms start, to prevent symptomatic heart failure.
Tobacco cessation and weight loss, if appropriate; regular exercise; moderate salt restriction; and managing cholesterol all have benefit in improving the heart (and overall health) in people with abnormal left ventricular relaxation or heart failure with preserved ejection fraction.
Dr. Roach regrets that he is unable to answer individual letters, but will incorporate them in the column whenever possible. Readers may email questions to [email protected]
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