Short of breath in the night

By Richard P. Holm, MD

Joe was a middle-aged guy, smart and full of personality. He had developed Hodgkin's lymphoma a number of years back, had chemotherapy and radiation to his chest as part of his treatment, which successfully shrunk the malignant lymph nodes there, and brought him back to a normal cancer-free life.

Recently he had been waking up in the night feeling like he was suffocating. He told me he would go to the window, throw open the sash, and breath in the cool autumn air to get relief. For a week now he found that he was more comfortable sleeping in the recliner. He had also noted that he had been having trouble walking any distance and he got short of breath just coming up from the basement.

On exam, as I listened to his lungs I could hear crackles, and as I listened to his heart I noted it was beating a hundred times per minute sounding like a horse galloping. His neck veins seemed distended and there was swelling of his ankles. He wondered if there was something wrong with his lungs.

The problem was not with his lungs, but rather with his heart. Although the name for his condition is called congestive heart failure, I think the word failure sounds too doomed and guilt-ridden. I would rather it be called heart weakness instead, because we have treatment to remove the excess water, ease the load on his heart, and there shouldn't be doom or guilt about it.

Normally blood returns to the heart from veins into that mighty pump as it fills and dilates during the relaxation phase. When the heart squeezes, the entrance valves slam shut, and the only way out is past the exit valves. Repeating this cycle with relax-then-squeeze past one-way-valves, the heart pump pushes blood out to supply every cell with the oxygen and nutrients needed to flourish.

Causes for heart weakness are myriad including long standing high blood pressure, blockage of coronary arteries, a life-time of excessive alcohol or inadequate nutrition, viral infections of the heart muscle, valves that leak or are too tight, and the list goes on. 

Joe's heart was weak partly from radiation injury and probably from a viral infection. Just the right balance of medications gave him relief and hope for a future.