Marian Zander

It takes a lot to slow down Marian Zander. Throughout her life, she's been an elementary school teacher for six years — including a stint teaching overseas in France; a stay-at-home mother for seventeen years to four children born within three years — a son, twins boys and a daughter; and a laboratory technician for a food processing company for twenty years. Through it all, Marian stayed physically active, riding her bike to work, taking daily walks and enjoying "seasonal pleasures," as she calls them — gardening, mowing lawn, raking leaves and shoveling snow.

But, at age 69, Marian's life had changed drastically from the on-the-go schedule she usually enjoyed. She had a hard time catching her breath. She was unable to climb the stairs without a struggle. She had to sleep in a chair because she couldn't breathe lying down.

Several years earlier, doctors at Mayo Clinic had diagnosed Marian with dilated cardiomyopathy, a disease in which the heart's left ventricle becomes enlarged and its pumping ability decreases. With medication, her disease seemed to be under control. Marian thought she had it beat.

When it resurfaced worse than ever, she went back to Mayo Clinic. Physicians at Mayo are recognized worldwide as leaders in the diagnosis and treatment of cardiomyopathy and myocarditis — a condition sometimes related to cardiomyopathy that involves an inflammation of the muscular layer of the heart wall. With their help, Marian has been able to reclaim her life.

An unlikely diagnosis

When, at 65, Marian first began experiencing pain in her abdomen and back, developed a dry cough and couldn't shake the fatigue that plagued her, she was concerned. When the doctors at Mayo Clinic told her she had a heart condition, she was stunned.

"I rode my bicycle everyday. I ate healthfully I hadn't gained much weight. I enjoyed my work, which involved standing and walking all day," she says. "It was a shock to find there was something wrong with my heart."

According to Leslie Cooper, M.D., Marian's cardiologist at Mayo Clinic, her surprise was well-founded. "People who do regular aerobic exercise tend to have a much lower risk of developing heart failure than people who are sedentary," he says. "In otherwise healthy people, a virus can cause cardiomyopathy. But, this is quite uncommon."

Although the doctors couldn't tell Marian exactly what caused her condition, the damaging affect it was having on her life was obvious. They prescribed heart medication, a beta blocker, and suggested she consider retiring. She did.

"After I retired, I started feeling better," says Marian. "I relaxed. Life wasn't as strenuous. Then, I made the mistake of not taking my medication."

A limited reprieve

Marian's life progressed smoothly, for a while. But, four years after her original diagnosis, she began to experience edema. Her legs and ankles doubled in size. Her heart was unable to pump enough blood to her kidneys to remove the fluid. She started having shortness of breath.

"In order to climb stairs, I had to stop to catch my breath after each step," says Marian. "I could do three at the most. Then I would just lean on the banister and get enough air to go up a few more. Many times I felt I was suffocating because of the fluid buildup. It scared me."

Marian returned to Mayo Clinic. "I went back to the clinic expecting to be scolded for not taking my medicine," she says. "But, those doctors were so kind. They overlooked all that and took care of me."

Dr. Cooper tested the ejection fraction of Marian's heart to measure the capacity at which it was pumping. During each heartbeat, the heart contracts and relaxes. When the heart contracts, it ejects blood from the pumping chambers (ventricles). When the heart relaxes, the ventricles refill with blood. No matter how forceful the contraction, it doesn't empty all of the blood out of a ventricle. Ejection fraction refers to the percentage of blood that is pumped out of a filled ventricle with each heartbeat. A normal ejection fraction is 55 to 70 percent. Marian's was 10 to 15 percent.

"Marian was very sick when I saw her. She was in the advanced stages of congestive heart failure," says Dr. Cooper. "But, since we got her back on her medication and helped her make some diet changes, she has done beautifully."

A new attitude

Once she began taking the beta blockers again, Marian was determined to do everything she could to get healthy and stay healthy. That has included being faithful about taking her medication and sticking to the low-salt, reduced-fluid diet Dr. Cooper and his colleagues recommend for patients with cardiomyopathy.

"When our family comes home and we're having a fabulous meal and dessert, I sometimes want to say, 'To heck with the diet.' I feel it afterward, though. I get a tingling in my ankles if I eat too much salt. I have consequences if I don't follow the guidelines. When I do follow them, I feel better," says Marian. "I know that if I let my condition take over, I would be physically miserable. Taking my medication, staying on the diet and keeping track of what I eat and drink helps me feel in control of my health. That's valuable to me."

Marian's discipline has paid off. Her heart's ejection fraction has rebounded to normal levels, and she has been able to return to many of her active pursuits. Each morning, Marian gets up early and rides her bike around a lake near her home. In the afternoons, she often takes a two-mile walk. She's also back to enjoying her yard work, no matter what the season. Recently, she and her husband traveled to visit their children who live in different parts of the country. Those trips weren't possible when she was sick.

"Compounded with the aging process, I know I am slowing down," she says. "I fight against that because I like to be active and moving all the time. But, I know it's for the good of my heart. In a way, it's rather nice to have this excuse to take life a little easier, enjoy it more and not have to feel guilty doing that."

While she was battling the symptoms of congestive heart failure, Marian wondered if she would ever be able to return to the life she enjoyed. With the guidance of her care team at Mayo Clinic, she's found a way back.

"It was daunting for me to think, 'Am I going to have edema for the rest of my life? Am I going to feel this fatigue, shortness of breath and suffocation always?'" Marian says. "I have been relatively free of those frightening symptoms for three years. Relief from my symptoms humbles me. I am so thankful, so grateful, that I had doctors and nurses at Mayo Clinic who knew what to do to help me."