A Question of Health: Heart of the matter

Three years ago during a routine medical examination I was found to have a heart murmur. I was referred to a cardiologist who arranged an echocardiogram scan. This showed a narrowing of the aortic valve. Since then I have not had any problems except for some shortness of breath when I climb steep inclines or stairs. I follow a low fat diet and am careful about sudden exertion. Is it possible that my condition will remain stable, given the strict regime that I follow, or is surgery inevitable?

HEART OF THE MATTER

Three years ago during a routine medical examination I was found to have a heart murmur. I was referred to a cardiologist who arranged an echocardiogram scan. This showed a narrowing of the aortic valve. Since then I have not had any problems except for some shortness of breath when I climb steep inclines or stairs. I follow a low fat diet and am careful about sudden exertion. Is it possible that my condition will remain stable, given the strict regime that I follow, or is surgery inevitable?

The aortic valve controls the flow of blood from the heart into the aorta, which is the body's biggest blood vessel. When the valve becomes narrowed – this is known as aortic stenosis – the flow of blood through the valve is restricted. The narrower the valve becomes, the more difficult it is for the heart to pump blood out through it. The commonest symptoms of aortic stenosis are shortness of breath, dizziness or blackouts, and chest pain. The aortic valve can become quite narrowed before symptoms appear. Specialists believe that it is not necessary to undertake surgery before the development of symptoms. Once symptoms do appear, however, you need careful monitoring as they can progress very quickly, sometimes with life-threatening effects. Your breathlessness could be an early symptom, and you must tell the cardiologist about this. Regular echocardiogram scans are the best way to keep an eye on what is happening with the valve. A low-fat diet may slow the rate of progression.

RINGING IN THE EAR

I suffered a deadened right ear after a car accident. This effect lasted for several days and was eventually replaced with tinnitus – a constant noise in the right ear. An MRI scan showed a surprising result. There is a tumour called an acoustic neuroma in the inner canal of my left ear. I do not have any symptoms on the left side. The MRI did not show anything wrong on the right side, which is the side with the tinnitus. It seems likely to me that the acoustic neuroma in my left inner ear is also the result of the impact explosion that went through my head in the car accident. Can I please have your opinion?

It seems clear that the tinnitus in your right ear is the result of the car accident. The fact that the right ear went "dead" after the accident, and then developed tinnitus, means that the inner part of the ear was damaged by the impact of the accident. It recovered to some extent, but the tinnitus is a continuing manifestation of the damage that was caused. I am not surprised that the MRI did not show anything on the right side. MRI scans are not usually able to detect the cause of tinnitus. The acoustic neuroma on the left side is completely unrelated to your accident. The fact that is was discovered by an MRI is a lucky coincidence. Acoustic neuromas are rare tumours that grow on the auditory nerve. This is the nerve that connects the inner part of the ear to the brain. They are benign tumours (non-cancerous), and they grow very slowly. As they enlarge, they begin to cause problems, either with hearing, or because they are pressing on critical areas of the brain. As your right ear is already in trouble, it is particularly important that great care is taken to preserve the hearing in your left ear. This will certainly mean regular MRI scans to watch the growth of the neuroma. It may need to be removed, but the surgery for this is delicate. Small tumours are much easier to treat than big ones. The American Acoustic Neuroma Association has an informative website at www.anausa.org.

SALT OR WATER?

I have recently made an effort to cut down the amount of salt I eat. I was not eating many processed foods but have reduced the amount of salt that I use in cooking and in salad dressings. My problem is that I am now finding it difficult to drink the suggested two litres of water a day. If I increase my salt intake I do not have this problem. Is it better for me to eat less salt and drink less water, or vice versa? I am 23 years of age and female. I exercise three times a week and am otherwise healthy.

Cutting down on salt intake is a good idea, because most of us eat much more salt than our bodies need. You rightly point out that processed foods contain lots of salt. In fact, about 85 per cent of our salt intake is hidden in other foods, including bread, which makes a major contribution to the salt intake of many people. I'm not sure why you think that you must drink two litres of water a day. The best guide to how much you should drink is how thirsty you feel. Some foods, particularly fruits and vegetables, contain a lot of water. So even if the human body does need two litres of water a day, much of it can come from food, rather than liquids. In warm weather you will need to drink more, and strenuous exercise will make you sweat. In both situations, you are going to feel thirstier. I would suggest that it is healthier for you to eat less salt and drink less water. But don't get obsessed by the two-litre "rule".

Have your say

Advice from PR about problems with bladder control:

Don't despair – there's a lot that can be done. Phone The Continence Foundation Helpline, 0845 345 0165. They will listen sympathetically, and send you written advice, which I have found very helpful.

SB has bladder problems because she has multiple sclerosis:

I have found that propiverine works better for me than tolteridone, and does not cause a dry mouth as oxybutinin does. I also find that desmopressin nasal spray is very effective at night.

Please send your questions and answers to A Question of Health, 'The Independent', Independent House, 191 Marsh Wall, London E14 9RS; fax to 020-7005 2182 or e-mail to health@independent.co.uk. Dr Kavalier regrets that he is unable to respond personally to questions