Cardiac Arrest and Heart Friendly Diet

Cardiac arrest is when the heart suddenly and unexpectedly stops beating. It is a medical emergency that without immediate medical intervention will result within minutes in sudden cardiac death. Cardiopulmonary resuscitation (CPR), and possibly defibrillation are needed until further treatment can be provided. Cardiac arrest results in a rapid loss of consciousness, and breathing may be abnormal or absent. While cardiac arrest may be caused by heart attack or heart failure, these are not the same, and in 15 to 25% of cases, there is a non-cardiac cause. Some individuals may experience chest pain, shortness of breath, nausea, an elevated heart rate, and feeling light-headed immediately before entering cardiac arrest.

Meaning of Cardiac arrest

Cardiac arrest is the abrupt loss of heart function in a person who may or may not has been diagnosed with heart disease. It can come on suddenly or in the wake of other symptoms. It is often fatal if appropriate steps aren’t taken immediately.

Cardiac arrest Symptoms

Cardiac arrest is not preceded by any warning symptoms in approximately 50 percent of people. For individuals who do experience symptoms, the symptoms are usually nonspecific to cardiac arrest. This can present in the form of new or worsening:

• Chest pain,
• Fatigue,
• Blackouts,
• Dizziness,
• Shortness of breath,
• Weakness, and
• Vomiting.

When a cardiac arrest is suspected due to signs of unconsciousness or abnormal breathing, a bystander should attempt to feel a pulse for 10 seconds; if no pulse is felt, it should be assumed the victim is in cardiac arrest. As a result of loss of cerebral perfusion (blood flow to the brain), the person will rapidly lose consciousness and can stop breathing. 

Cardiac arrest Risk factors

The risk factors for sudden cardiac arrest (SCA) are similar to those of coronary artery disease and include:

• Age,
• Cigarette smoking,
• High blood pressure,
• High cholesterol,
• Lack of physical exercise,
• Obesity,
• Diabetes, and
• A family history of cardiac disease.

A prior episode of sudden cardiac arrest also increases the likelihood of future episodes. A statistical analysis of many of these risk factors determined that approximately 50% of all cardiac arrests occur in 10% of the population.

Sudden cardiac death in children

Previous adverse cardiac events, non-sustained ventricular tachycardia (NSVT), syncope, and left ventricular hypertrophy (LVT) have been shown to predict sudden cardiac death in children.

Current cigarette smokers with coronary artery disease were found to have a two to threefold increase in the risk of sudden death between ages 30 and 59. Furthermore, it was found that former smokers’ risk was closer to that of those who had never smoked.

Cardiac arrhythmia

Functional changes in the heart such as reduced ejection fraction or cardiac arrhythmia have been shown to increase the risk of cardiac arrest and act independently from the risk factors previously mentioned.

Conditions that produce these functional changes can be acquired following previous cardiac injury, or inherited through the familial history of arrhythmogenic disorders.

Cardiac arrest Causes

Sudden cardiac arrest (SCA), or sudden cardiac death (SCD), occurs when the heart abruptly begins to beat in an abnormal or irregular rhythm (arrhythmia). Without organized electrical activity in the heart muscle, there is no consistent contraction of the ventricles, which results in the heart’s inability to generate an adequate cardiac output (forward pumping of blood from the heart to the rest of the body).

Sudden cardiac arrest can result from cardiac and non-cardiac causes including the following:

Cardiac causes

Coronary artery disease

Coronary artery disease (CAD), also known as ischemic heart disease, is responsible for 62 to 70 percent of all sudden cardiac deaths. CAD is a much less frequent cause of sudden cardiac death in people under the age of 40.

Cases have shown that the most common finding at postmortem examination of sudden cardiac death is chronic high-grade stenosis of at least one segment of a major coronary artery, the arteries that supply the heart muscle with its blood supply.

This stenosis is often the result of narrowing and hardening of the arteries following the deposition of cholesterol plaques and inflammation over several years. This accumulation and remodeling of the coronary vessels along with other systemic blood vessels characterizes the progression of Atherosclerotic Cardiovascular Disease. When a stable plaque ruptures, it can block the flow of blood and oxygen through small arteries resulting in ischemic injury as a result. 

Non-atherosclerotic coronary artery abnormalities

Abnormalities of the coronary arteries not related to atherosclerosis include:

• Congenital coronary artery anomalies (most commonly anomalous origin of the left coronary artery from the pulmonary artery),
• Inflammation is known as coronary arteritis,
• Embolism,
• Vasospasm, and
• Mechanical abnormalities related to connective tissue diseases or trauma.

These conditions account for 10-15% of cardiac arrests and sudden cardiac death.

• Coronary arteritis commonly results from a pediatric febrile inflammatory condition known as Kawasaki disease. Other vasculitides can also contribute to an increased risk of sudden cardiac death.
• Embolism, or clotting, of the coronary arteries, most commonly occurs from septic emboli secondary to endocarditis with involvement of the aortic valve, tricuspid valve, or prosthetic valves.
• Coronary vasospasm may result in cardiac arrhythmias, altering the electrical conduction of the heart with a risk of complete cardiac arrest from severe or prolonged rhythm changes.
• Mechanical abnormalities with the associated risk of cardiac arrest may arise from coronary artery dissection which can be attributed to Marfan Syndrome or trauma.

Structural heart disease

Structural heart diseases not related to coronary artery disease account for 10% of all sudden cardiac deaths. Examples of these include:

• Cardiomyopathies (hypertrophic, dilated, or arrhythmogenic),
• Cardiac rhythm disturbances,
• Myocarditis,
• Hypertensive heart disease, and
• Congestive heart failure.

Left ventricular hypertrophy is thought to be a leading cause of sudden cardiac death in the adult population. This is most commonly the result of longstanding high blood pressure, or hypertension, which has caused a maladaptive change to the wall of the main pumping chamber of the heart, the left ventricle. 

Inherited arrhythmia syndromes

Arrhythmias that are not due to structural heart disease account for 5 to 10% of sudden cardiac arrests. These are frequently caused by genetic disorders that lead to abnormal heart rhythms.

The genetic mutations often affect specialized proteins known as ion channels that conduct electrically charged particles across the cell membrane, and this group of conditions is therefore often referred to as channelopathies.

Non-cardiac causes

Non-cardiac causes account for 15 to 25% of cardiac arrests. The most common non-cardiac causes are:

• Trauma,
• Major bleeding (gastrointestinal bleeding, aortic rupture, or intracranial hemorrhage),
• Hypovolemic shock,
• Overdose,
• Drowning, and
• Pulmonary embolism.

Cardiac arrest can also be caused by poisoning like the stings of certain jellyfish, or through electrocution, like lightning.

Reversible causes

Other non-cardiac causes of cardiac arrest may result from temporary disturbances in the body’s homeostasis. This may be the result of changes in electrolyte ratios, oxygen saturation, or alterations of other ions influencing the body’s pH.

Mnemonic for reversible causes

“Hs and Ts” is the name for a mnemonic used to remember the treatable or reversible causes of cardiac arrest. Note: This mnemonic includes causes of cardiac and non-cardiac origin, but all are reversible with appropriate and time-sensitive treatment.

Hs

• Hypovolemia – A lack of blood volume
• Hypoxia – A lack of oxygen
• Hydrogen ions (acidosis) – An abnormal pH in the body
• Hyperkalemia or hypokalemia – Both increased and decreased potassium can be life-threatening
• Hypothermia – A low core body temperature
• Hypoglycemia or hyperglycemia – A low or high blood glucose

Ts

• Tablets or toxins such as drug overdose
• Cardiac tamponade – Fluid building up around the heart
• Tension pneumothorax – A collapsed lung
• Thrombosis (myocardial infarction) – A heart attack
• Thromboembolism (pulmonary embolism) – A blood clot in the lung
• Traumatic cardiac arrest

Children

In children, the most common cause of cardiopulmonary arrest is shock or respiratory failure that has not been treated. Heart arrhythmia is not the most common cause in children. When there is a cardiac arrhythmia, it is most often asystole or bradycardia, in contrast to ventricular fibrillation or tachycardia as seen in adults.

Other causes can include drugs such as cocaine, methamphetamine, or overdose of medications such as antidepressants in a child who was previously healthy but is now presenting with a dysrhythmia that has progressed to cardiac arrest. Common causes of sudden unexplained cardiac arrest in children include:

• Hypertrophic cardiomyopathy,
• Coronary artery abnormalities, and
• Arrhythmias.

Cardiac arrest Diagnosis

Historical information

Cardiac arrest is synonymous with clinical death. Historical information and a physical exam can diagnose cardiac arrest and provide information regarding the potential cause and prognosis.

The provider taking the person’s clinical history should aim to determine if the episode was observed by anyone else, what time the episode took place, what the person was doing (in particular if there was any trauma), and if there were involvement of drugs.

Physical examination

The physical examination portion of diagnosing cardiac arrest focuses on the absence of a pulse. In many cases, a lack of a carotid pulse is the gold standard for diagnosing cardiac arrest. Lack of a pulse in the periphery (radial/pedal) may also result from other conditions (e.g. shock), or simply an error on the part of the rescuer.

Studies have shown that rescuers may often make a mistake when checking the carotid pulse in an emergency, whether they are healthcare professionals or lay persons.

Ultrasound (POCUS)

Point-of-care ultrasound (POCUS) is a tool that can be used to examine the movement of the heart and its force of contraction at the person experiencing cardiac arrest’s bedside.

POCUS can accurately diagnose cardiac arrest in hospital settings, overcoming some of the shortcomings of diagnosis through checking the central pulse (carotid arteries or subclavian arteries), as well as detecting movement and contractions of the heart.

Using POCUS, clinicians can have limited, two-dimensional views of different parts of the heart during the arrest. These images can help clinicians determine whether electrical activity within the heart is pulseless or pseudo-pulseless, as well as help them diagnose the potentially reversible causes of an arrest. 

Technique to check carotid pulses

Owing to the inaccuracy of this method of diagnosis, some bodies such as the European Resuscitation Council (ERC) have de-emphasized its importance. Instead, the current guidelines prompt individuals to begin CPR on any unconscious person who has absent or abnormal breathing.

ERC’s recommendations

The Resuscitation Council in the United Kingdom stands in line with the ERC’s recommendations and those of the American Heart Association. They have suggested that the technique to check carotid pulses should be used only by healthcare professionals with specific training and expertise, and even then that it should be viewed in conjunction with other indicators such as agonal respiration.

Other physical signs of cardiac arrest

Other physical signs or symptoms can help determine the potential cause of cardiac arrest. Below is a chart of the clinical findings and signs/symptoms a person may have and a potential cause associated with it.

Physical Findings Related to Potential Causes

Location	Findings	Possible Causes
General	Pale skin	Hemorrhage
	Decreased body temperature	Hypothermia
Airway	Presence of secretions, vomit, blood	Aspiration
	Inability to provide positive pressure ventilation	Tension pneumothoraxAirway obstruction
Neck	Distension of the neck veins	Tension pneumothoraxCardiac tamponade Pulmonary embolism
	The trachea shifted to one side	Tension pneumothorax
Chest	Scar in the middle of the sternum	Cardiac disease
Lungs	Breath sounds only on one side	Tension pneumothoraxRight mainstem intubation Aspiration
	No breath sounds or distant breath sounds	Esophageal intubationAirway obstruction
	Wheezing	AspirationBronchospasm Pulmonary edema
	Rales	AspirationPulmonary edema Pneumonia
Heart	Decreased heart sounds	HypovolemiaCardiac tamponade Tension pneumothorax Pulmonary embolus
Abdomen	Distended and dull	Ruptured abdominal aortic aneurysm Ruptured ectopic pregnancy
	Distended and tympanic	Esophageal intubation
Rectal	Blood present	Gastrointestinal hemorrhage
Extremities	Asymmetrical pulses	Aortic dissection
Skin	Needle tracks	Drug abuse

Cardiac arrest Classifications

Clinicians classify cardiac arrest into “shockable” versus “non-shockable”, as determined by the EKG rhythm. This refers to whether a particular class of cardiac dysrhythmia is treatable using defibrillation.

The two “shockable” rhythms are ventricular fibrillation and pulseless ventricular tachycardia, while the two “non-shockable” rhythms are asystole and pulseless electrical activity.

Cardiac arrest Prevention

With the lack of positive outcomes following cardiac arrest, efforts have been spent finding effective strategies to prevent cardiac arrest. With the prime causes of cardiac arrest being ischemic heart disease, efforts to promote a healthy diet, exercise, and smoking cessation are important.

For people at risk of heart disease, measures are used such as:

• Blood pressure control,
• Cholesterol-lowering, and
• Other medico-therapeutic interventions.

However, both the lifetime and acute risk of cardiac arrest is decreased in individuals with heart disease that perform regular exercise, suggesting the risks of exercise are outweighed by the benefits.

Diet for Cardiac arrest

According to a study published in the Journal of the American Heart Association in 2021, diet may be a modifiable risk factor that leads to a lower incidence of sudden cardiac death.

Added fats

The study found that those who fell under the category of having “Southern diets” representing those of “added fats, fried food, eggs, organ, processed meats, and sugar-sweetened beverages” had a positive association with an increased risk of cardiac arrest.

While those deemed following the “Mediterranean diets” of had an inverse relationship regarding the risk of cardiac arrest. The American Heart Association also has diet recommendations here that are aimed to prevent cardiovascular disease. 

Omega-3

Additionally, marine-derived omega-3 polyunsaturated fatty acids (PUFAs) have been promoted for the prevention of sudden cardiac death due to their postulated ability to lower triglyceride levels, prevent arrhythmias, decrease platelet aggregation, and lower blood pressure.

However, according to a systematic review published in 2012, omega-3 PUFA supplementation is not associated with a lower risk of sudden cardiac death.

Code teams

In medical parlance, cardiac arrest is referred to as a “code” or a “crash”. This typically refers to “code blue” on the hospital emergency codes.

A dramatic drop in vital sign measurements is referred to as “coding” or “crashing”, though coding is usually used when it results in cardiac arrest, while crashing might not. Treatment for cardiac arrest is sometimes referred to as “calling a code”.

Specialist staff

The specialist staff is being used more effectively in order to augment the work already being done at the ward level. These include:

• Crash teams (or code teams) – These are designated staff members with particular expertise in resuscitation who are called to the scene of all arrests within the hospital. This usually involves a specialized cart of equipment (including a defibrillator) and drugs called a “crash cart” or “crash trolley”.
• Medical emergency teams – These teams respond to all emergencies, with the aim of treating people in the acute phase of their illness in order to prevent a cardiac arrest. These teams have been found to decrease the rates of in-hospital cardiac arrest and improve survival.
• Critical care outreach – As well as providing the services of the other two types of teams, these teams are also responsible for educating non-specialist staff. In addition, they help to facilitate transfers between intensive care/high dependency units and the general hospital wards.

Implantable cardioverter defibrillator

An implantable cardioverter defibrillator (ICD) is a battery-powered device that monitors electrical activity in the heart and when an arrhythmia is detected is able to deliver an electrical shock to terminate the abnormal rhythm.

ICDs are used to prevent sudden cardiac death (SCD) in those that have survived a prior episode of sudden cardiac arrest (SCA) due to ventricular fibrillation or ventricular tachycardia (secondary prevention). ICDs are also used prophylactically to prevent sudden cardiac death in certain high-risk patient populations (primary prevention).

Cardiac arrest Treatment

Sudden cardiac arrest may be treated via attempts at resuscitation. This is usually carried out based on basic life support, advanced cardiac life support (ACLS), pediatric advanced life support (PALS), or neonatal resuscitation program (NRP) guidelines.

Cardiopulmonary resuscitation

Early cardiopulmonary resuscitation (CPR) is essential to surviving cardiac arrest with good neurological function. It is recommended that it be started as soon as possible with minimal interruptions once begun. The components of CPR that make the greatest difference in survival are chest compressions and defibrillating shockable rhythms.

After defibrillation, chest compressions should be continued for two minutes before a rhythm check is again done. Longer durations of CPR may be reasonable in those who have a cardiac arrest while in hospital. Bystander CPR, by the lay public, before the arrival of EMS also improves outcomes.

Advanced airway

Either a bag valve mask or an advanced airway may be used to help with breathing particularly since vomiting and regurgitation are common, particularly in out-of-hospital cardiac arrest (OHCA). If this occurs, then a modification to existing oropharyngeal suction may be required, such as the use of Suction Assisted Laryngoscopy Airway Decontamination.

High levels of oxygen are generally given during CPR. Tracheal intubation has not been found to improve survival rates or neurological outcomes in cardiac arrest and in the prehospital environment may worsen it. Endotracheal tubes and supraglottic airways appear equally useful. When done by EMS 30 compressions followed by two breaths appear better than continuous chest compressions and breaths being given while compressions are ongoing.

Mouth-to-mouth respiration

For bystanders, CPR which involves only chest compressions results in better outcomes as compared to standard CPR for those who have gone into cardiac arrest due to heart issues. Mouth-to-mouth as a means of providing respirations to the patient has been phased out due to the risk of contracting infectious diseases from the patient.

Mechanical chest compressions (as performed by a machine) are no better than chest compressions performed by hand. It is unclear if a few minutes of CPR before defibrillation results in different outcomes than immediate defibrillation. If cardiac arrest occurs after 20 weeks of pregnancy someone should pull or push the uterus to the left during CPR. If a pulse has not returned by four minutes emergency Cesarean section is recommended.

Defibrillation

Defibrillation is indicated if an electric-shockable heart rhythm is present. The two shockable rhythms are ventricular fibrillation and pulseless ventricular tachycardia. In children, 2 to 4 J/Kg is recommended.

The defibrillation is made by an automated external defibrillator (AED), a portable machine that can be used even by any user because it produces voice instructions that guide the process, automatically checks the victim’s condition and applies the correct electric shocks.

Medications for Cardiac arrest

As of 2016, medications other than epinephrine (adrenaline), while included in guidelines, have not been shown to improve survival to hospital discharge following out-of-hospital cardiac arrest. This includes the use of atropine, lidocaine, and amiodarone. Epinephrine in adults

Thrombolytics when used generally may cause harm but may be of benefit in those with a confirmed pulmonary embolism as the cause of arrest. Evidence for use of naloxone in those with cardiac arrest due to opioids is unclear but it may still be used. In those with cardiac arrest due to local anesthetic, lipid emulsion may be used.

Targeted temperature management

Current international guidelines suggest cooling adults after cardiac arrest using targeted temperature management (TTM), which was previously known as therapeutic hypothermia.

People are typically cooled for a 24-hour period, with a target temperature of 32–36 °C (90–97 °F). There are a number of methods used to lower the body temperature, such as applying ice packs or cold-water circulating pads directly to the body or infusing cold saline. This is followed by gradual rewarming over the next 12 to 24 hrs.

Do not resuscitate

Some people choose to avoid aggressive measures at the end of life. A do not resuscitate order (DNR) in the form of an advance health care directive makes it clear that in the event of cardiac arrest, the person does not wish to receive cardiopulmonary resuscitation.

Other directives may be made to stipulate the desire for intubation in the event of respiratory failure or, if comfort measures are all that is desired, by stipulating that healthcare providers should “allow natural death”.

Chain of survival

Several organizations promote the idea of a chain of survival. The chain consists of the following “links”:

• Early recognition If possible, recognition of illness before the person develops a cardiac arrest will allow the rescuer to prevent its occurrence. Early recognition that a cardiac arrest has occurred is key to survival for every minute a patient stays in cardiac arrest, their chances of survival drop by roughly 10%.
• Early CPR improves the flow of blood and of oxygen to vital organs, an essential component of treating a cardiac arrest. In particular, by keeping the brain supplied with oxygenated blood, the chances of neurological damage are decreased.
• Early defibrillation is effective for the management of ventricular fibrillation and pulseless ventricular tachycardia
• Early advanced care
• Early post-resuscitation care which may include percutaneous coronary intervention

If one or more links in the chain are missing or delayed, then the chances of survival drop significantly.

Although you might know that eating certain foods can increase your heart disease risk, changing your eating habits is often tough. Whether you have years of unhealthy eating under your belt or simply want to fine-tune your diet, here are eight heart-healthy diet tips. Once you know which foods to eat more of and which foods to limit, you’ll be on your way toward a heart-healthy diet.

Control your portion size

How much you eat is just as important as what you eat. Overloading your plate, taking seconds, and eating until you feel stuffed can lead to eating more calories than you should. Portions served in restaurants are often more than anyone needs.

Following a few simple tips to control food portion size can help you shape up your diet as well as your heart and waistline:

• Use a small plate or bowl to help control your portions.
• Eat more low-calorie, nutrient-rich foods, such as fruits and vegetables
• Eat smaller amounts of high-calorie, high-sodium foods, such as refined, processed, or fast foods.

It’s also important to keep track of the number of servings you eat. Some things to keep in mind:

• A serving size is a specific amount of food, defined by common measurements such as cups, ounces, or pieces. For example, one serving of pasta is about 1/3 to 1/2 cup, or about the size of a hockey puck. A serving of meat, fish, or chicken is about 2 to 3 ounces, or about the size and thickness of a deck of cards.
• The recommended number of servings per food group may vary depending on the specific diet or guidelines you’re following.
• Judging serving size is a learned skill. You may need to use measuring cups and spoons or a scale until you’re comfortable with your judgment.

Eat more vegetables and fruits

Vegetables and fruits are good sources of vitamins and minerals. They are also low in calories and rich in dietary fiber. Vegetables and fruits, like other plants or plant-based foods, contain substances that may help prevent cardiovascular disease. Eating more fruits and vegetables may help you cut back on higher-calorie foods, such as meat, cheese, and snack foods.

Featuring vegetables and fruits in your diet can be easy. Keep vegetables washed and cut in your refrigerator for quick snacks. Keep fruit in a bowl in your kitchen so that you’ll remember to eat it. Choose recipes that have vegetables or fruits as the main ingredients, such as vegetable stir-fry or fresh fruit mixed into salads.

Fruits and vegetables to choose	Fruits and vegetables to limit
Fresh or frozen vegetables and fruits Low-sodium canned vegetables Canned fruit packed in juice or water	Coconut Vegetables with creamy sauces Fried or breaded vegetables Canned fruit packed in heavy syrup Frozen fruit with sugar added

Select whole grains

Whole grains are good sources of fiber and other nutrients that play a role in regulating blood pressure and heart health. You can increase the number of whole grains in a heart-healthy diet by making simple substitutions for refined grain products. Or be adventuresome and try a new whole grain, such as whole-grain farro, quinoa, or barley.

Grain products to choose	Grain products to limit or avoid
Whole-wheat flour Whole-grain bread, preferably 100% whole-wheat bread or 100% whole-grain bread High-fiber cereal with 5 g or more fiber in a serving Whole grains such as brown rice, barley, and buckwheat (kasha) Whole-grain pasta Oatmeal (steel-cut or regular)	White, refined flour White bread Muffins Frozen waffles Cornbread Doughnuts Biscuits Quick bread Cakes Pies Egg noodles Buttered popcorn High-fat snack crackers

Limit unhealthy fats

Limiting how much saturated and trans fats you eat is an important step to reducing your blood cholesterol and lowering your risk of coronary artery disease. A high blood cholesterol level can lead to a buildup of plaques in the arteries, called atherosclerosis, which can increase the risk of heart attack and stroke.

The American Heart Association offers these guidelines for how much fat to include in a heart-healthy diet:

Type of fat	Recommendation
Saturated fat	Less than 6% of total daily calories.* If you’re eating 2,000 calories a day, that’s about 11 to 13 grams.
Trans fat	Avoid

Simple ways

There are simple ways to cut back on saturated and trans fats:

• Trim fat off meat or choose lean meats with less than 10% fat.
• Use less butter, margarine, and shortening when cooking and serving.
• Use low-fat substitutions when possible for a heart-healthy diet. For example, top a baked potato with low-sodium salsa or low-fat yogurt rather than butter, or use the sliced whole fruit or low-sugar fruit spread on toast instead of margarine.

Check the food labels of cookies, cakes, frostings, crackers, and chips. Not only are these foods low in nutritional value, some — even those labeled reduced fat — may contain trans fats. Trans fats are no longer allowed to be added to foods, but older products may still contain them. Trans fats may be listed as partially hydrogenated oil on the ingredient label.

Fats to choose	Fats to limit
Olive oil Canola oil Vegetable and nut oils Margarine, trans-fat-free Cholesterol-lowering margarine, such as Benecol, Promise Activ, or Smart Balance Nuts, seeds Avocados	Butter Lard Bacon fat Gravy Cream sauce Nondairy creamers Hydrogenated margarine and shortening Cocoa butter, found in chocolate Coconut, palm, cottonseed, and palm kernel oils

When you do use fats, choose monounsaturated fats, such as olive oil or canola oil. Polyunsaturated fats, found in certain fish, avocados, nuts, and seeds, also are good choices for a heart-healthy diet. When used in place of saturated fat, monounsaturated and polyunsaturated fats may help lower your total blood cholesterol. But moderation is essential. All types of fat are high in calories.

Omega-3 fatty acids

An easy way to add healthy fat (and fiber) to your diet is to use ground flaxseed. Flaxseeds are small brown seeds that are high in fiber and omega-3 fatty acids. Studies have shown that flaxseed lowers unhealthy cholesterol levels in some people. You can grind the flaxseeds in a coffee grinder or food processor and stir a teaspoon of them into yogurt, applesauce, or hot cereal.

Choose low-fat protein sources

Lean meat, poultry and fish, low-fat dairy products, and eggs are some of the best sources of protein. Choose lower fat options, such as skinless chicken breasts rather than fried chicken patties and skim milk rather than whole milk.

Fish is a good alternative to high-fat meats. Certain types of fish are rich in omega-3 fatty acids, which can lower blood fats called triglycerides. You’ll find the highest amounts of omega-3 fatty acids in cold-water fish, such as salmon, mackerel, and herring. Other sources are flaxseed, walnuts, soybeans, and canola oil.

Legumes — beans, peas, and lentils — also are good, low-fat sources of protein and contain no cholesterol, making them good substitutes for meat. Substituting plant protein for animal protein — for example, a soy or bean burger for a hamburger — will reduce fat and cholesterol intake and increase fiber intake.

Proteins to choose	Proteins to limit or avoid
Low-fat dairy products, such as skim or low-fat (1%) milk, yogurt, and cheese Eggs Fish, especially fatty, cold-water fish, such as salmon Skinless poultry Legumes Soybeans and soy products, such as soy burgers and tofu Lean ground meats	Full-fat milk and other dairy products Organ meats, such as liver Fatty and marbled meats Spareribs Hot dogs and sausages Bacon Fried or breaded meats

Limit or reduce salt (sodium)

Eating too much salt can lead to high blood pressure, a risk factor for heart disease. Limiting salt (sodium) is an important part of a heart-healthy diet. The American Heart Association recommends that:

• Healthy adults have no more than 2,300 milligrams (mg) of sodium a day (about a teaspoon of salt)
• Most adults ideally have no more than 1,500 mg of sodium a day

Although reducing the amount of salt you add to food at the table or while cooking is a good first step, much of the salt you eat comes from canned or processed foods, such as soups, baked goods, and frozen dinners. Eating fresh foods and making your own soups and stews can reduce the amount of salt you eat.

Foods lower in sodium

If you like the convenience of canned soups and prepared meals, look for ones with no added salt or reduced sodium. Be wary of foods that claim to be lower in sodium because they are seasoned with sea salt instead of regular table salt — sea salt has the same nutritional value as regular salt.

Another way to reduce the amount of salt you eat is to choose your condiments carefully. Many spices are available in reduced-sodium versions. Salt substitutes can add flavor to your food with less sodium.

Low-salt items to choose	High-salt items to limit or avoid
Herbs and spices Salt-free seasoning blends Canned soups or prepared meals with no added salt or reduced salt Reduced-salt versions of condiments, such as reduced-salt soy sauce and reduced-salt ketchup	Table salt Canned soups and prepared foods, such as frozen dinners Tomato juice Condiments such as ketchup, mayonnaise, and soy sauce Restaurant meals

Plan ahead: Create daily menus

Create daily menus using the six strategies listed above. When selecting foods for each meal and snack, emphasize vegetables, fruits, and whole grains. Choose lean protein sources and healthy fats, and limit salty foods. Watch your portion sizes and add variety to your menu choices.

For example, if you have grilled salmon one evening, try a black bean burger the next night. This helps ensure that you’ll get all of the nutrients the body needs. Variety also makes meals and snacks more interesting.

Allow yourself an occasional treat

Allow yourself an indulgence every now and then. A candy bar or handful of potato chips won’t derail your heart-healthy diet. But don’t let it turn into an excuse for giving up on your healthy-eating plan. If overindulgence is the exception, rather than the rule, you’ll balance things out over the long term. What’s important is that you eat healthy foods most of the time.

Include these eight tips into your life, and you’ll find that heart-healthy eating is both doable and enjoyable. With planning and a few simple substitutions, you can eat with your heart in mind.

Reference: https://en.wikipedia.org/wiki/Cardiac_arrest