DASH Eating Plan

DASH stands for Dietary Approaches to Stop Hypertension. It is an eating plan that is based on research studies sponsored by the National Heart, Lung, and Blood Institute (NHLBI). These studies showed that DASH lowers high blood pressure and improves levels of cholesterol. This reduces your risk of getting heart disease.

The DASH eating plan:

• Emphasizes vegetables, fruits, and whole-grains
• Includes fat-free or low-fat dairy products, fish, poultry, beans, nuts, and vegetable oils
• Limits foods that are high in saturated fat. These foods include fatty meats, full-fat dairy products, and tropical oils such as coconut, palm kernel, and palm oils.
• Limits sugar-sweetened beverages and sweets

Along with DASH, other lifestyle changes can help lower your blood pressure. They include staying at a healthy weight, exercising, and not smoking.

NIH: National Heart, Lung, and Blood Institute

How to Prevent Heart Disease

Heart disease is the leading cause of the death in the United States. It is also a major cause of disability. But you can take steps to improve your health and help prevent heart disease. The first step is understanding your risk of heart disease. Your risk depends on many factors, some of which are changeable and others that are not. Learning about them and working on the things that you can change can lower your risk of heart disease.

What are the heart disease risk factors that I cannot change?

There are some risk factors for heart disease that you cannot change:

• Your age. Your risk of heart disease increases as you get older. The risk is higher in:
  • Men age 45 and older
  • Women age 55 and older
• Your sex. Some risk factors may affect heart disease risk differently in women than in men. For example:
  • The hormone estrogen provides women some protection against heart disease
  • Diabetes raises the risk of heart disease more in women than in men.
• Your race or ethnicity. Certain groups have higher risks than others. For example:
  • African Americans are more likely than Whites to die of heart disease, while Hispanic Americans are less likely to die of it
  • Asian Americans as a group have lower rates of heart disease than other groups, but South Asian Americans have higher rates
• Your family history. You have a greater risk if you have a close family member who had heart disease at an early age, for example if:
  • Your father or brother was diagnosed before age 55
  • Your mother or sister was diagnosed before age 65

What are the heart disease risk factors I can change and what can I do to lower my risk?

There are many heart disease risk factors that you can change. If you make these changes, you don't just help protect your heart. You can also improve your overall health and well-being.

You may have a lot of changes to make. If you need to, you can make the changes gradually, one at a time. What's most important is that you make them. Depending on your lifestyle, these changes could include:

• Controlling your blood pressure.High blood pressure is a major risk factor for heart disease. It is important to get your blood pressure checked regularly - at least once a year for most adults, and more often if you have high blood pressure. You can also take steps, including lifestyle changes, to prevent or control high blood pressure.
• Keeping your cholesterol and triglyceride levels under control:
  • High levels of cholesterol can clog your arteries and raise your risk of coronary artery disease and heart attack. Lifestyle changes and medicines (if needed) can lower your cholesterol.
  • Triglycerides are another type of fat in the blood. High levels of triglyceride may also raise the risk of coronary artery disease, especially in women.
• Staying at a healthy weight. Being overweight or having obesity can increase your risk of heart disease. This is mostly because they are linked to other heart disease risk factors, including high blood cholesterol and triglyceride levels, high blood pressure, and diabetes. Controlling your weight can lower these risks.
• Eating a healthy diet. Try to limit saturated fats, foods high in sodium (salt), and added sugars. Instead, eat plenty of fresh fruit, vegetables, and whole grains. The DASH diet is an example of an eating plan that can help you to lower your blood pressure and cholesterol, two things that can lower your risk of heart disease.
• Getting regular physical activity. Regular physical activity has many benefits, including strengthening your heart and improving your circulation. It can also help you maintain a healthy weight and lower cholesterol and blood pressure. All of these can lower your risk of heart disease.
• Limiting alcohol. Drinking too much alcohol can raise your blood pressure. It also adds extra calories, which may cause weight gain. Both of those raise your risk of heart disease. It's best not to drink, but if you do:
  • Have no more than 2 drinks per day if you are a man.
  • Have no more than 1 drink per day if you are a woman.
• Not smoking. Cigarette smoking raises your blood pressure and puts you at higher risk of heart attack and stroke.
  • If you do not smoke, don't start.
  • If you do smoke, quitting will lower your risk of heart disease. You can talk with your health care provider for help in finding the best way for you to quit.
• Managing stress.Stress is linked to heart disease in many ways. It can raise your blood pressure. Extreme stress can be a "trigger" for a heart attack. Also, some common ways of coping with stress, such as overeating, heavy drinking, and smoking, are bad for your heart. Some ways to help manage your stress include exercise, listening to music, focusing on something calm or peaceful, and meditating.
• Managing diabetes. Having diabetes doubles your risk of diabetic heart disease. That is because over time, high blood glucose (blood sugar) from diabetes can damage your blood vessels and the nerves that control your heart and blood vessels. So, it is important to get tested for diabetes, and if you have it, to keep it under control.
• Getting enough sleep. If you don't get enough sleep, you raise your risk of high blood pressure, obesity, and diabetes. Those three things can raise your risk of heart disease. To improve your sleep:
  • If you are an adult, try to get 7 to 9 hours of sleep per night.
  • Make sure that you have good sleep habits, such as keeping a regular sleep schedule and creating a good sleeping environment in your bedroom.
  • If you have frequent sleep problems, contact your health care provider. One problem, sleep apnea, causes people to briefly stop breathing many times during sleep. This interferes with your ability to get a good rest and can raise your risk of heart disease. If you think you might have sleep apnea, ask your provider about having a sleep study. And if you do have sleep apnea, make sure that you get treatment for it.

Brain Diseases

Your brain is the control center of your body. It controls your thoughts, memory, speech, and movement. It regulates the function of many organs. It's part of your nervous system, which also includes your spinal cord and peripheral nerves. The nervous system sends signals between your brain and the rest of the body. Your nerves take in information from your senses and send it to the brain to be processed. Your brain and nerves also communicate to help you move and to control your body's functions.

When the brain is healthy, it works quickly and automatically. But when you have a brain disease, it may affect how well you can function and do your daily activities. Some common brain diseases include:

• Brain tumors, which can press on nerves and affect brain function.
• Degenerative nerve diseases, which can affect many of your body's activities, such as balance, movement, talking, breathing, and heart function. Types include Alzheimer's disease and Parkinson's disease.
• Encephalitis (inflammation in the brain), which can lead to problems such as vision loss, weakness, and paralysis.
• Genetic brain disorders, which are caused by changes in genes (also called variants or mutations). These disorders can affect the development and function of the brain.
• Strokes, which can cause a loss of brain cells and can affect your ability to think clearly.
• Traumatic brain injuries (TBIs), which can affect brain function. They may range from mild to severe. The effects of a TBI may be temporary or permanent.

The symptoms of brain diseases vary widely, depending on the specific problem. In some cases, damage is permanent. In other cases, treatments such as surgery, medicines, or therapies such as physical, occupational, and speech therapies, may cure the disease or improve the symptoms.

Atrial Fibrillation

What is atrial fibrillation (AFib)?

Atrial fibrillation, also known as AFib or AF, is one of the most common types of arrhythmias. Arrhythmias are problems with the rate or rhythm of your heartbeat. They can cause your heart to beat too slowly, too fast, or in an irregular way.

If you have AFib, your heart beats irregularly and sometimes much faster than normal. Also, your heart's upper and lower chambers do not work together as they should. When this happens, the lower chambers do not fill completely or pump enough blood to your lungs and body. This can cause symptoms such as dizziness, fatigue, and a pounding heartbeat.

AFib may happen in brief episodes, or it may be a permanent condition. It's very important to treat it, since AFib can put you at risk for stroke and other heart conditions.

What causes atrial fibrillation (AFib)?

AFib is most often caused by changes to the heart's tissue or the electrical signaling that helps the heartbeat. These changes can happen due to different conditions and factors, such as high blood pressure, coronary artery disease, congenital heart defects, infections, and aging. Sometimes the cause is unknown.

Who is more likely to develop atrial fibrillation (AFib)?

Anyone can develop AFib, but there are certain things that raise your risk for it:

• Aging. The risk of atrial fibrillation increases as you get older, especially when you are over age 65.
• Family history and genetics. AFib can run in families. So can heart disease, which raises your risk of AFib.
• Some lifestyle choices. Your risk is higher if you drink a lot of alcohol, use certain illegal drugs such as cocaine and methamphetamines, or smoke.
• Having certain health conditions, such as:
  • High blood pressure
  • Diabetes
  • Heart failure
  • Heart valve diseases
  • Obesity
  • Hyperthyroidism
  • Chronic kidney disease
  • COPD and other lung diseases
  • Sleep apnea
• Race. AFib is more common in people with European ancestry.
• Recent surgery. You may be at risk of atrial fibrillation in the early days and weeks after surgery on your heart, lungs, or esophagus.

What are the symptoms of atrial fibrillation (AFib)?

Some people who have AFib don't have any symptoms and don't know they have it. If you do have symptoms, you may only notice them once in a while. Or you may have symptoms that are more frequent. And in some cases, the symptoms might be severe. If you have heart disease, you are more likely to notice your symptoms. And those symptoms could get worse if your heart disease gets worse.

The symptoms of AFib can include:

• Extreme fatigue, which is the most common symptom
• Heart palpitations (the feeling that your heart is skipping a beat, fluttering, pounding, or beating too hard or too fast)
• Trouble breathing, especially when lying down or when exercising
• Chest pain
• Dizziness or fainting
• Low blood pressure

What other problems can AFib cause?

If AFib is not treated, it can lead to serious health problems (complications) such as:

• Stroke
• Heart failure
• Blood clots
• Sudden cardiac arrest (SCA)
• Cognitive impairment and dementia

To help prevent these problems, it's important to contact your health care provider if you are having symptoms. If you do have AFib, the sooner you are diagnosed and treated, the better.

How is atrial fibrillation (AFib) diagnosed?

To find out if you have AFib, your provider:

• Will ask about your medical history, including your symptoms, lifestyle, and any other health conditions you may have
• Will ask about your family history, to find out if you have relatives who have or had AFib
• Will do a physical exam
• May order blood tests
• Will likely order heart tests, such as an electrocardiogram (also called an EKG or ECG) and echocardiogram
• May ask you to wear a heart monitor device that records your heart's electrical activity

What are the treatments for atrial fibrillation (AFib)?

The treatments for AFib may include:

• Blood thinner medicines that help prevent blood clots from forming.
• Medicines to control your heart's rhythm and rate.
• Following heart-healthy lifestyle changes, such as:
  • Following a heart-healthy eating plan that limits saturated fats, salt, and cholesterol. An example is the DASH eating plan.
  • Limiting or avoiding alcohol, because it can increase your heart rate.
  • Aiming for a healthy weight.
  • Getting regular physical activity.
  • Managing stress.
  • Quitting smoking.
• Procedures such as:
  • Electrical cardioversion, which restores your heart rhythm using low-energy shocks to your heart.
  • Catheter ablation, which scars the tissue that is causing the arrhythmia. The scar tissue blocks the abnormal heart signals.
• Surgeries such as:
  • Surgery to put in a pacemaker to help control the arrhythmia.
  • A Maze procedure, which creates scar tissue in a maze-like pattern in certain parts of the heart.
  • Left atrial appendage closure, a surgery on a small sac in the muscle wall of your left atrium (the upper left chamber of your heart). It helps prevent blood clots and can reduce your risk of stroke. This surgery is for people who are not able to take blood thinners.

Can atrial fibrillation (AFib) be prevented?

There are steps you can take to help lower your risk of atrial fibrillation, such as:

• Making heart-healthy lifestyle changes:
  • Following a heart-healthy eating plan
  • Limiting or avoiding alcohol
  • Aiming for a healthy weight
  • Getting regular physical activity
  • Managing stress
  • Not smoking
• Avoiding illegal drugs, such as cocaine and methamphetamines
• Taking antiarrhythmic medicine (medicine to treat arrhythmia) if you are having heart surgery
• Treating any health conditions that could raise your risk of AFib

NIH: National Heart, Lung, and Blood Institute

Congenital Heart Defects

What are congenital heart defects?

Congenital heart defects (CHDs) are problems with the structure of the heart. "Congenital" means that that the problems are present at birth. These defects happen when a baby's heart doesn't develop normally during pregnancy. Congenital heart defects are the most common type of birth defect.

Congenital heart defects can change the way the heart pumps blood. They may make blood flow too slowly, go the wrong way, or block it completely.

There are many types of congenital heart defects. They can happen in one or more parts of the heart. The most common types are:

• Septal defects ("hole in the heart") - openings in the wall between the left and right sides of the heart
• Heart valve defects - problems with the valves that control the flow of blood through the heart
• Defects in the large blood vessels that carry blood in and out of the heart

Congenital heart defects can range from very mild problems that never need treatment to life-threatening problems at birth. The most serious congenital heart defects are called critical congenital heart disease. Babies with these defects usually need surgery in the first year of life. But the symptoms of milder heart defects may not show up until childhood or adulthood.

What causes congenital heart defects?

Researchers often don't know what causes congenital heart defects. They do know that changes in a baby's genes sometimes cause a heart defect. The changed genes may come from the parents, or the changes may happen during pregnancy.

Who is more likely to have a baby with a congenital heart defect?

Several things may increase the chance that your baby has a congenital heart defect, such as:

• Your health before and during pregnancy, including:
  • Having diabetes before pregnancy or developing it in the first 3 months of pregnancy (diabetes that develops later in pregnancy isn't a major risk for heart defects). Carefully controlling your blood sugar before and during pregnancy can lower your baby's risk of congenital heart defects.
  • Having phenylketonuria (PKU), a rare inherited disorder that affects how the body uses a protein in foods. If you have PKU, eating a low-protein diet before getting pregnant can lower your baby's risk of having a congenital heart defect.
  • Having rubella (German measles) during pregnancy.
• Your contact with certain substances during pregnancy, including:
  • Smoking or secondhand smoke (breathing smoke from another smoker).
  • Certain medicines, such as angiotensin-converting (ACE) inhibitors for high blood pressure and retinoic acids for acne. If you're pregnant or plan to get pregnant, talk with your health care provider about all the medicines you take.
• Your family history and genetics. In most cases, congenital heart defects don't run in families. But your chance of having a baby with a congenital heart defect does go up if you or the other parent has a congenital heart defect, or if you already have a child with a congenital heart defect.

What are the symptoms of congenital heart defects?

Congenital heart defects don't cause pain. The signs and symptoms are different, depending on the type and number of defects and how serious they are.

Common signs and symptoms of congenital heart defects include:

• Cyanosis - a bluish color to the skin, lips, and fingernails. It happens when there isn't enough oxygen in the blood.
• Fatigue - your baby may be unusually sleepy and may become very tired during feedings.
• Poor blood flow.
• Fast or difficult breathing.
• Heart murmur - an unusual sound between heartbeats.

What other problems do congenital heart defects cause?

Congenital heart defects don't always cause other problems. If they do, which problems you have would depend on the type and number of defects and how serious the defects are.

Children with congenital heart defects are more likely to:

• Be smaller than other children
• Have problems or delays in mental, and emotional growth, and behavior, such as:
  • Speech and language problems
  • Attention deficit hyperactivity disorder (ADHD)

People with congenital heart defects may develop other health conditions, including:

• Endocarditis - an infection of lining of the heart and valves
• Arrhythmia - a problem with the rate or rhythm of your heartbeat
• Heart failure - when your heart can't pump enough blood to the body
• Pulmonary hypertension - high blood pressure in your lungs
• Kidney and liver disease

How are congenital heart defects diagnosed?

• Before a baby is born, your provider may use ultrasound pictures of the baby's heart to look for heart defects. This is called a fetal echocardiogram. It's done between weeks 18 and 22 of pregnancy.
• During the first few days after birth, all newborns are checked for congenital heart defects. A pulse oximeter is clipped to your baby's hands or feet to measure blood oxygen. If it shows low levels of blood oxygen, more tests will be needed to find out if your baby has a heart defect.
• To diagnose congenital heart defects in babies, children, and adults, a provider may use many tools, including:
  • A physical exam.
  • Certain heart tests to see how the heart is working.
  • Genetic testing to see if certain gene problems caused the defect.

What are the treatments for congenital heart defects?

Treatment depends on the type of congenital heart defect and how serious it is. Possible treatments include:

• Cardiac catheterization to repair simple defects, such as a small hole in the inside wall of the heart. A catheterization uses a thin tube guided through a vein and into the heart.
• Heart surgery may be needed to:
  • Repair defects in the heart and blood vessels.
  • Repair or replace a heart valve.
  • Place a device in the chest to help the heart pump blood.
  • Do a heart transplant.
• Medicine is often used if your baby has a specific type of congenital heart defect called patent ductus arteriosus.

All children and adults who have congenital heart defects need regular follow-up care from a cardiologist (a doctor who specializes in heart diseases) throughout their life, even if their defect was repaired.

Some people may need several heart surgeries or catheterizations over the years. They may also need to take medicines to help their hearts work as well as possible.

NIH: National Heart, Lung, and Blood Institute