Heart Health Archive

Ask the doctor

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Q. Is it possible to have a heart attack even if you don't have any blockages in your heart's arteries?

A. Yes, you can. Doctors refer to heart attacks without blocked arteries as MINOCA, which stands for myocardial infarction (that is, heart attack) with non-obstructive coronary arteries. When it occurs, people may experience typical heart attack symptoms, such as chest pressure or pain in the center of the chest (or the arms, jaw, neck, or stomach) and trouble breathing. They also have elevated blood levels of a protein called troponin, a marker of heart damage that is used to diagnose a heart attack. But the next test — a special x-ray of the heart's arteries called an angiogram — shows no evidence of a significant buildup of fatty plaque blocking any of the heart's arteries.

The Internet is rife with dubious dietary advice for heart health. Here's how to separate the wheat from the chaff.

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Surfing the Web nearly always involves running into a few ads, blogs, and articles about diet and health. Perhaps you also have relatives or friends who send you links about what you should (or shouldn't) be eating to lose weight, lower your blood pressure, or dodge heart disease.

You might be skeptical enough to avoid clicking on suspicious links, like those once-popular ads promising "one weird trick to banish belly fat." Yet sometimes the advice appears to be from a legitimate source — for instance, a purported world-class heart surgeon who's written books about diet and nutrition. But what if the recommendations run counter to what you've mostly heard about a heart-healthy diet? It's no wonder many people feel confused and frustrated about nutrition.

How fast is fast enough? About 100 steps per minute might be a reasonable goal, but your mileage may vary.

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Walking can be a wonderful way to get exercise. But do you ever wonder if you're moving briskly enough to benefit your heart? There's a quite a difference between a leisurely neighborhood stroll and a purposeful gait when you're late for the bus. Now, new research suggests that a pace of about 100 steps per minute qualifies as brisk walking for many people (see "Take this in stride: A study of walking speed").

Using that cadence as a benchmark might make sense for some — but not all — people, says Dr. Beth Frates, who directs wellness programming for the Stroke Research and Recovery Institute at Harvard-affiliated Spaulding Rehabilitation Hospital. "For example, 100 steps per minute could be a good goal for a middle-aged, relatively healthy person who's walking on a mild day when the conditions allow for safe footing." In fact, that pace might even seem a bit slow for a fit person who exercises regularly, she says.

Operations to fix faulty mitral valves are on the rise. But less invasive nonsurgical strategies are under development.

The mitral valve — so named because it resembles a miter, a bishop's formal headdress — sits between the two chambers on the left side of your heart. Inherited conditions, diseases, or a combination of the two can cause changes in the size, shape, flexibility, or mechanics of the mitral valve, leaving it unable to close properly. When that happens, blood may flow backward between heartbeats, a problem called regurgitation.

While mild cases are generally harmless and cause no symptoms, more severe cases can increase the heart's workload, leading to breathlessness, fatigue, and other symptoms. Mitral valve regurgitation also produces a distinct sound (heart murmur) that a doctor may hear through a stethoscope.

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Just a few years ago, cauliflower was considered kind of ho-hum, relegated mainly to frozen vegetable medleys or crudité platters. But these days, the mild white vegetable is far more popular, thanks to its versatility as a carbohydrate substitute. Recent diet trends that encourage people to eat fewer starchy and grain-based foods likely contributed to cauliflower's rise.

Even if you're not avoiding carbs, using cauliflower as a substitute for starchy foods such as rice is a good way to cut calories and eat more fiber. You can also make mashed cauliflower instead of mashed potatoes (see www.hsph.harvard.edu/nutritionsource/mashed-cauliflower). Or try making a pizza with one of the many cauliflower-based pizza crusts now available in most grocery stores.

Research we're watching

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Do you take generic drugs to lower your blood pressure or cholesterol? You may save money by paying out of pocket at Walmart instead of a paying a Medicare prescription copay, according to an analysis in the July 24 Annals of Internal Medicine.

Walmart (and a number of other large chain stores) offer generic drug discount plans; they sell 30-day supplies of popular generic drugs for $4.

Research we're watching

People with heart disease who eat a traditional Southern diet (rich in meat and fried foods) may be more likely to die sooner than people who follow a plant-based Mediterranean-style diet.

So says a study in the July 12 Journal of the American Heart Association that focused on people with a history of heart disease, such as a heart attack or bypass surgery. Researchers conducted dietary assessments on 3,562 people ages 45 and older and tracked them for about seven years.

Research we're watching

An experimental nasal spray shows promise for quickly treating an abnormally fast heart rhythm known as supraventricular tachycardia (SVT), a new study reports.

Caused by an electrical misfire that overrides the heart's natural pacemaker, SVT occurs unpredictably, lasting anywhere from minutes to hours. Although usually harmless, the condition can make people dizzy or lightheaded. People with persistent SVT usually need to go to an emergency room for an injection of a drug to slow the heart.

Research we're watching

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Aggressively treating high blood pressure might help ward off cognitive changes, according to findings presented at the Alzheimer's Association International Conference in July. Researchers from the Systolic Blood Pressure Intervention Trial compared two strategies to manage high blood pressure in more than 9,300 older adults (average age about 68). One strategy aims to achieve the standard treatment level for high systolic blood pressure (the first number in a blood pressure reading), keeping it under 140 mm Hg. The more aggressive strategy sets a goal of less than 120 mm Hg. The aggressive strategy reduced not only heart risks, but seemed to protect the brain.

People in the more aggressively controlled blood pressure group were 19% less likely than those in the standard treatment group to develop new cases of mild cognitive impairment (often a forerunner to dementia). They were also 15% less likely to develop any form of dementia or mild cognitive impairment. This study provides another reason to work with your doctor to reduce high blood pressure.