Dietetic treatment of chronic heart disease will be influenced by the following considerations : -
1. The cause, e.g. rheumatism, gout, Bright's disease, etc.
2. The age of the patient.
3. The nature of the particular lesion present.
4. The condition of the heart as to : -
(a) Perfect compensation.
(b) Disturbed compensation.
(c) Extreme failure.
It is unnecessary here to discuss the best dietary for cases of rheumatism, gout, Bright's disease and so forth. They will receive full attention elsewhere. But it is necessary to emphasize the point that, when heart trouble has been caused by one of these diseases, it becomes more than ever important in its treatment to insist upon the appropriate diet being adhered to. If we wish the heart condition to get better, or at any rate to get no worse, we must see that its cause is not allowed to be a progressive one; and there can be no doubt that the course of such conditions as gout, rheumatism and Bright's disease can, amongst other things, be influenced profoundly by diet.
The reader is referred to the articles on the various diseases indicated, and is reminded that although the condition of the patient, or his heart, may need some modification from time to time in the regime there laid down, the main rules are usually applicable.
In adult cases a limitation of food is often beneficial and sometimes essential. Limitation of food is not, as a rule, wise in the case of children. The growth and development of the body has to be maintained, and a fairly liberal dietary will be found the best for them. Children under ten years of age are notoriously bad subjects for heart disease; and although everything would seem to be in their favour, it is frequently the case that complete compensation is never attained. The formation of hypertrophy is often well carried out in children, the coronary vessels are healthy, there is no general arteriosclerosis, and yet we constantly see compensation only temporarily effected, soon to give way to dilatation and failure. The double call upon the vital powers for growth and development and at the same time for the establishment of a compensatory hypertrophy, and the extra work thrown upon the heart by the general development of the body prove too great a strain. It is a noticeable fact that this failure to create a permanent compensation is much more common among poor children than among those of the well-to-do, and although it may in part be accounted for by lack of care in other ways, insufficiency of proper nourishment is the main cause. What is true of acquired disease is even more so of congenital heart disease, and the prevalence shown for such cases to drift into acute or chronic tuberculosis makes a liberal supply of nourishment even more important.
It is important, therefore, in the case of children, not to keep them too long on a low diet when recovering from acute endocarditis, or when compensating after a temporary breakdown. When the trouble is over they should be fed liberally during the time compensation is forming. It is often necessary, in the case of adults, especially in those of full habit, to keep them on a somewhat low diet, though, except in cases of fatty infiltration, plethoric states and gout, starvation methods may easily be pushed too far. In the case of old people, a fixed regime is often harmful. It must be remembered that few real heart cases live to over sixty years of age, and if they do, they are generally feeble and debilitated, and need a free and liberal diet with a certain amount of alcohol. The general question of the use of alcohol in heart cases will be dealt with more fully later.
Probably in most cases of chronic heart disease it is wise to limit the consumption of fluids; but this is especially necessary where there is stenosis of a valve or extreme dilatation of one or more of the cavities. In such cases soups and broths should be avoided, the meals should be taken as dry as possible and a limited amount of fluid, as drink, taken with or preferably in between them. The same rule holds good where the arterial tension is excessive or where dropsy is present.
In cases of fatty heart where there is infiltration rather than degeneration, and where the heart is more incommoded by the presence of the fat than actually diseased, a modification of the diet is generally necessary. Such patients are the victims of general adiposity. Fats and starches must be reduced to a minimum, and their diet should consist chiefly of fish, chicken, green vegetables and a limited amount of butcher's meat. It is generally advisable for such cases to take a rather increased amount of fluid in the form of water, and to avoid the use of alcohol. As a warning one must add that the depletion of the body fat must not be carried out too rapidly, and that as the fat on the body and round the heart is removed, it should be replaced as far as possible by muscle, and in order to attain this end massage, gymnastics and exercises are most helpful. Copious water drinking, a much restricted diet, various kinds of baths and a regular amount of exercise are remedies very easily enumerated, but nothing needs more careful thought and supervision than the decision as to how much each of these remedies should play a part in the treatment of any individual case. It is obvious that a patient cannot be drenched, starved and worked without very careful supervision, and much harm has been done by the reckless use of these methods of treatment without skilled advice. Further, although some cases of true heart disease are benefited by a somewhat modified course of such remedies, such a form of treatment is much more applicable to obese patients who are suffering from functional heart trouble only than to the victims of real morbus cordis.
For the sake of completeness the following dietary is given as suitable for a case of weak heart, especially when due to fatty overgrowth, and in patients whose heart trouble is due to overeating, overdrinking and deficient exercise : -
About 6 oz. of weak tea or coffee, with a little milk, and 3-4 oz. of bread.
3-4 oz. of soup, 7-8 oz. of meat, bird or fish, salad or light green vegetable, 1 oz. of bread, toast, or milk pudding, 4-6 oz. of fruit.
About 6 oz. of weak tea or coffee and 1-2 oz. of bread or stale sponge cake or rusk.
1 or 2 soft-boiled eggs, 1-2 oz. of bread, cheese and salad and a little fruit.
With this diet, it will be found that some cases do better when restricted in the amount of fluid taken to between 30 and 40 oz. altogether, whilst others do better when taking an increased amount of fluid (chiefly water), better taken between meals.
As already stated exercise forms an important element in the treatment of these cases.