Dear Dr. Cynthia:

Can you give me some information about an enlarged heart? How dangerous is it and what can you do about it? Are there things you should not be doing, such as exercising?

-- Mary

		About this column Dr. Cynthia Napier Rosenberg, a geriatric medicine specialist, writes a monthly Q&A on aging issues. You can write to her at P.O. Box 38607, Pittsburgh, PA 15238 or by e-mail to drcynthia@comcast.net. Indivicual responses cannot be provided. This column provides an overview and is not intended to replace consultation with your own doctor.

Dear Mary:

Our heart is essentially a blood-pumping muscle, and, like any muscle in our bodies, it works best when it is in the best shape. Try to imagine an enlarged heart as a heart in which the muscle fibers are stretched out and therefore do not contract as well as they might. The medical term for an enlarged heart is cardiomegaly. Cardiomegaly is not a specific disease, but a condition that can be caused by a variety of illnesses. It is usually first seen on a chest X-ray and confirmed by a cardiac sonogram (echocardiogram). The most common cause is heart failure, but not all people with heart failure have cardiomegaly. In addition, cardiomegaly can be mild or severe depending on the cause, the duration of the problem and whether or not the cause is treatable.

I would suggest that you (or the person you're writing for) talk to your doctor and ask him or her to tell you the cause of your enlarged heart. The most important factor for successfully managing the cardiomegaly will be successful treatment of the underlying cause.

Regarding exercise, the answer is yes and no. If you have cardiomegaly (and therefore some type of underlying heart problem), you should not exercise without medical supervision. However, in most cases, supervised cardiovascular exercise, such as what you would get in a cardiac rehabilitation program, could be a very important component of your treatment. Talk to your doctor to see if you are a candidate for cardiac rehabilitation; and if so, ask for a referral. Then, make sure that your doctor stays in contact with your physical therapist and coordinates your exercise program with the rest of your treatment regimen.

Dear Dr. Cynthia:

Last year my aunt, who is 82 and still lives by herself, had a new roof put on her house. Under normal circumstances, that wouldn't be so unusual. But the problem is that this year, that new roof is having major repairs -- by the same contractor! When I brought this up with her, she said that there is a small leakage problem which needs to be fixed. When I told her that maybe we should check up on this roofer, she told me that she could handle it herself and that the roofer was a very nice man!

I am afraid that someone is taking advantage of her. I am her closest relative, but she is fiercely independent, and I don't want to offend her or hurt her feelings. Is there anything that I can do?

-- Anonymous

Dear Anonymous:

Unfortunately, as I'm sure you know, everyone in this world does not always do the right thing. And the elderly are statistically more likely to become the victims of unscrupulous behavior than younger adults. Their increased vulnerability can be due to a number of factors: physical frailty, social isolation and greater susceptibility to memory problems. In addition, the elderly population as a group tends to be more trusting.

I don't know if your aunt has any of the above problems, but an 82-year-old living alone is at risk for being taken advantage of, even if she is otherwise well. In addition, beginning memory problems can sometimes first manifest themselves as a subtle lack of judgment.

You are right to be concerned. It seems to me that your aunt's roof ought to be covered by a warranty, even if the new leak was unavoidable. I would do two things right away. First, have a conversation with your aunt, telling her that you don't mistrust her judgment but sometimes two brains are better than one. Ask her if you can talk to the roofer with her so that the two of you can best understand what the problem is. I would also investigate the roofing company with the Better Business Bureau. Do this before you talk to your aunt.

If your aunt refuses to let you be involved and if you begin to notice a pattern like this, contact Adult Protective Services through the Allegheny County Area Agency on Aging (412-350-6905). The goal of Adult Protective Services is to protect the older person who is at risk. They are advocates for the elderly and will be able to give you advice if the problem worsens.