Heart Failure Archive

A substance called trimethylamine N-oxide, which is produced when your body digests red meat, may raise the risk of cardiovascular problems.

Experts used to think that red meat raised your risk of heart disease simply because it was high in saturated fat. But today that picture has gotten more complicated thanks to the discovery of a metabolite — a substance produced during digestion and metabolism — called trimethylamine N-oxide, or TMAO.

According to a news article published June 11 in JAMA, three recent analyses have linked high blood levels of TMAO with a higher risk for both cardiovascular disease and early death from any cause. In one of those studies, researchers found that people with higher levels of TMAO in their blood may have more than twice the risk of heart attack, stroke, or other serious cardiovascular problems, compared with people who have lower levels. Other studies have found links between high TMAO levels and heart failure and chronic kidney disease.

Ask the doctor

Q. My cardiologist mentioned that he was going to do a "bubble study" during my echocardiogram. What is that?

A. During an echocardiogram, a technician uses a probe that emits high-frequency sound waves (ultrasound) that "echo" off the structures of your heart. The waves, which are translated into video images visible on a monitor, can reveal in-formation about your heart's structure and function. A bubble study gives added information, as it can identify potential blood flow issues inside your heart.

Research we're watching

A plant-focused diet long touted for its ability to lower blood pressure may also help prevent heart failure, according to a new study.

The DASH diet, which stands for Dietary Approaches to Stop Hypertension, emphasizes fruits, vegetables, whole grains, low-fat dairy products, poultry, fish, and nuts while minimizing salt, sugar, and red meat consumption.

Moderate workouts on most days of the week may be enough for heart-healing benefits.

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Good news: If you've spent most of your life as a competitive master athlete who trains more than six days a week (in addition to competitions) your heart probably looks and performs like one that is much younger than its chronological age.

Doesn't sound like you? Don't worry, there's also some good news for the rest of us. Even if you've spent more time hanging out than working out over the past few decades, starting an exercise program in middle age might earn you a younger-looking heart too.

But use is primarily a concern for people who take them over a long period or who have certain health risks.

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Numerous studies in recent years have raised concerns that common pain relievers known as nonsteroidal anti-inflammatory drugs (NSAIDs) increase the risk of cardiovascular problems, such as heart attack and stroke.

A study published September 4 in The BMJ seems to confirm the risks associated with NSAIDs and notes that one medication in particular — diclofenac (Voltaren) — is associated with even higher risks to cardiovascular health than others in the same category.

Research we're watching

 Image: © kali9/Getty Images

The more a middle-aged or older woman walks or does other exercise, the lower her risk of developing heart failure, a new study suggests. Heart failure — which means the heart is too weak or too stiff to pump enough blood through the body — affects some 5.7 million Americans.

Researchers tracked the exercise habits and heart health of more than 137,000 women who were ages 50 to 79 when the study began. After an average follow-up of 14 years, women who got at least some physical activity were 11% less likely to develop heart failure than those who didn't exercise at all — and those with the highest levels of physical activity were 35% less likely to develop heart failure.

Research we're watching

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Exercising regularly throughout life is the best way to keep your heart healthy. But starting to exercise even in late middle age may lessen the risk of heart failure, according to a report in the May 15 issue of Circulation. Heart failure, a gradual decline in the heart's ability to pump enough blood to meet the body's needs, affects about 6.5 million people in the United States.

The study involved more than 11,000 people who were part of a long-running project begun in the late 1980s, the Atherosclerosis Risk in Communities Study. Every six years, participants got medical testing and filled out questionnaires about their physical activity.

Ask the doctor

 Illustration by Scott Leighton

Q. I was recently admitted to the hospital with heart failure and received a heart ultrasound. The test report stated that my heart's pumping ability is normal. I don't understand. Was my diagnosis wrong, or is the test wrong?

A. If you were diagnosed with heart failure in the hospital, I'm presuming that you were admitted with symptoms such as shortness of breath, fatigue, and difficulty doing everyday activities. Other common symptoms include swelling in your legs and feet and trouble breathing at night.

After a Heart Attack

Questions to Discuss with Your Doctor:

• Have you had chest pain or pressure since you were discharged from the hospital?
• How severe is it?
• How long does it last?
• Does it stay in your chest or radiate to other parts of your body?
• Did you have this pain before your heart attack? What brings it on? How frequently do you get it?
• What were you doing just prior to the chest pain?
• Do you ever get chest pain or pressure at rest?
• What relieves the chest pain?
• If you take nitroglycerin, how many doses do you usually need to take before the pain goes away?
• How often do you take nitroglycerin?
• Do you get short of breath when you lie down or exert yourself?
• Do you awaken in the middle of the night short of breath?
• Do your ankles swell?
• Do you ever feel lightheaded?
• Have you fainted?
• Do you get rapid or pounding heartbeat for no reason?
• Do you know what each of the medications you are taking does?
• Do you know the side effects of each medication?
• Are you having any side effects?
• Are you taking an aspirin every day?
• Are you doing everything you can to modify the risk factors that can worsen your coronary artery disease (cigarette smoking, high blood pressure, high cholesterol, and diabetes are the most important risk factors)?
• Are you participating in a supervised exercise program?
• Are you resuming your normal activities?
• Are you sexually active?
• Have you returned to work?
• Have you been feeling depressed since your heart attack?
• Have you been able to reduce the stress in your life?
• Have you been fatigued?

Your Doctor Might Examine the Following Body Structures or Functions:

• Heart rate, blood pressure, and weight
• Pulses in your wrist, groin, and feet
• Listen over the major arteries in the neck, groin, and feet (for abnormal noises)
• Look at the veins in the neck to see if there is extra fluid in your body
• Heart and lungs
• Ankles and legs (for swelling)

Your Doctor Might Order the Following Lab Tests or Studies:

• Blood tests for glucose, lipid panel (cholesterol levels) and C-reactive protein (CRP)
• Electrocardiogram
• Echocardiogram
• Exercise stress test

Thiazide diuretics like hydrochlorothiazide (Esidrix, HydroDIURIL, other brands) continue to be a very effective way to lower blood pressure for people with hypertension. They're inexpensive, and results from large studies have shown them to be at least as effective as other types of blood pressure drugs for most patients.

But if you're taking a diuretic, your potassium levels need to be watched. These drugs direct the kidneys to pump water and sodium into the urine. Unfortunately, potassium also slips through the open floodgates. A low potassium level can cause muscle weakness, cramping, or an abnormal heartbeat, which is especially dangerous for people with heart problems.