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Research we're watching

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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

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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.

When a person develops heart failure without a good explanation for the underlying cause, a heart catheterization to check for blockages in the coronary arteries may be appropriate.

An app that detects an irregular heart rhythm could be reassuring for people worried about afib.

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Just over two years ago, the FDA approved the AliveCor Heart Monitor, which consists of a smartphone app plus a phone case with special sensors on the back. Touching the sensors with your fingers allows you to see a simple version of your heart's electrical activity on the phone screen. In the latest version, called Kardia, the sensors just need to be near (not necessarily on) your phone. The readout reveals if your heart rhythm looks normal or if you appear to have atrial fibrillation (afib)—a rapid, irregular heart rhythm that raises the risk of stroke.

Currently, several new smartphone apps to alert you about possible afib using just the phone itself—no special case required—are under development. Recent research suggests they're about as accurate as the Kardia system, although they haven't yet been cleared by the FDA and aren't on the market. If and when they are, could these apps help improve afib screening?

New research found that heart failure patients who had a flu shot had a 30% lower risk of hospitalization for cardiovascular disease, 16% lower risk of hospitalization for respiratory infections, and a 4% lower risk of hospitalization in general. 

Research we're watching

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If your summer vacation plans include a stop at one of the nation's major airline hubs, you can put your waiting time to good use by learning cardiopulmonary resuscitation (CPR). The American Heart Association and the Anthem Foundation partnered to provide interactive training kiosks that teach people how to perform hands-only CPR in just five minutes. The pilot kiosk program at the Dallas/Fort Worth International Airport has trained more than 25,000 people so far.

The training includes a short a "how-to" video followed by a practice session on a rubber torso. You'll receive feedback about proper hand placement and the correct depth and rate of chest compressions—factors that influence the effectiveness of CPR. More than 20% of the estimated 359,000 cardiac arrests that occur outside the hospital each year happen in public places like airports, casinos, and sporting facilities.

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News briefs

Here's another reason to take sweetened drinks out of your diet: a study published online Nov. 2, 2015, by the journal Heart suggests that drinking sweetened beverages each day is linked to an increased risk for heart failure in men. Heart failure is a gradual decline in the heart's ability to pump enough blood to meet the body's needs. Researchers tracked the dietary information of 42,000 middle-aged or older men in Sweden from 1998 to 2010. They made no distinction between types of drinks or how they were sweetened, whether it was with sugar, fructose, or artificial sweetener. However, coffee, tea, and fruit juice were not included in the study. After excluding potentially influential factors, researchers noted that men who drank at least two daily servings of sweetened drinks had a 23% heightened risk of developing heart failure compared with men who didn't drink sweetened beverages. The study didn't prove that sweetened drinks caused heart failure. In fact, the researchers pointed out that drinking a lot of sweetened beverages is usually an indication of a poor diet, which is a risk factor for heart failure in itself. But they also noted that sweetened drinks are associated with obesity and type 2 diabetes, which are risk factors for heart failure, too. Best advice: avoid sweetened beverages or at least limit them to occasional consumption.