This section is from the book "Practical Dietetics With Special Reference To Diet In Disease", by William Gilman Thompson. Also available from Amazon: Practical Dietetics with Special Reference to Diet in Disease.
The proper dietetic treatment of advanced heart disease deserves careful consideration, for on it to a great extent depends the patient's comfort, if not the prolongation of his life. It cannot be said that the several conditions of cardiac enlargement, valvular disease, fatty degeneration, etc., demand different forms of treatment per se, but there are certain general principles which should be observed in any case when particular symptoms arise. The dietetics of cardiac diseases may, accordingly, be conveniently reviewed together.
The general conditions involved are largely physical, or rather mechanical - perhaps more so than in any other form of disease.
1. We have to deal with a pump whose action is impaired by more or less weakness of its walls, or leakage or obstruction of its valves, or which is overworked by the imposition of increased resistance.
2. The balance of food pressure in the vessels is usually disturbed and the rate of blood flow is altered.
3. As the disproportion increases between the driving force or the resistance of the vessels and the volume of the fluid to be propelled, there is apt to be leakage of serum in various situations, producing dropsies or general anasarca. Or these conditions may result from a diminution in the vitality of the peripheral blood vessels or changes in the composition of the blood itself.
4. The rate of absorption of the materia alimentaria by osmosis depends as much upon the activity of the circulation - i. e., upon the rapidity of renewal of the layer of blood in the capillaries of the absorbing surface - as upon the density and composition of the blood, the action of individual cells, or any other factor. A feebly beating heart or an obstructed vascular system promptly checks absorption. Moreover, the reabsorption of transuded serum will depend upon the reversal of the conditions which originally caused it.
5. The elimination of waste and the various processes of secretion depend upon almost identical conditions with absorption, and while not due merely to filtration, they are nevertheless controlled very promptly by alterations in blood pressure and in the velocity of the current.
Bearing in mind these elementary principles, the first question which arises in the dietetic treatment of advanced cardiac disease must concern the administration of fluids.
An additional pint of fluid beyond the needs of the system may be sufficient to overtax the heart, alter the balance of blood pressure, disturb a temporary compensation, and precipitate anasarca, renal congestion, pulmonary oedema, or other symptoms. On the other hand, with too little fluid the blood pressure may fall to a dangerous degree or there may not be water enough in the vascular system to maintain the free diuretic action which is so desirable. It is a well-known physiological fact that the heart, like any other muscle, does better work if it has reasonable resistance to overcome. Such are the problems, briefly stated, which must be met by the comparison from day to day of the amount and quality of the urine, the degree of arterial tension, the force of the heart beat, and the possible presence of oedema.
It is difficult to formulate any but the most general rules for the dietetic treatment of chronic valvular disease of the heart. These cases often extend through a period of many years, and the variety of secondary symptoms which may appear is very great. The forms of valvular disease which are most apt to result in disturbances of digestion are those in which obstructed venous circulation results in local engorgement of the abdominal viscera, producing nausea, vomiting, and great distaste for food. Constipation and more or less chronic gastric and intestinal catarrh may be among the symptoms. The hypostatic congestion of the liver retards the activity of that organ, and the ingredients of the food which are brought to it by the portal system are no longer properly elaborated, so that general nutrition and assimilation suffer in consequence. A depleting diet is, therefore, sometimes to be recommended, and concentrated food is required to prevent overburdening the circulation. If gastric catarrh necessitates the use of fluid food, the quantity of beverages taken in addition should be considerably restricted.
When acute attacks of indigestion supervene in the course of chronic valvular disease, the bowels should be kept thoroughly open, and a diet of milk, beaten eggs, and broths, taken once in three hours, must be prescribed for a few days, after which boiled fish, broiled chicken, scraped beef, beefsteak, or rare roast beef may be added. Fats, farinaceous foods, and sugars should not be allowed, owing to their tendency to produce flatulency and aggravate existing symptoms. The use of alcoholic stimulation may at times become necessary, and whisky diluted in some non-effervescing water is perhaps the best. Beer should be particularly avoided, and recommendation of the regular use of stimulants, in this as in other forms of chronic disease, should be made with great caution lest the alcoholic habit be acquired and become permanent. Patients with sudden cardiac dilatation, such as sometimes occurs during convalescence from typhoid fever, need to return to a milk diet.
When acute symptoms of palpitation, dyspnoea, etc., develop, the patient should never eat very much food at one time. It is better to take four or five meals a day, if necessary, and eat only small quantities. A large meal always distends the stomach considerably for several hours, causing this organ to elevate the diaphragm and displace somewhat the heart, which lies upon it, and diminishing the vertical diameter of the chest. The heart may become irritated by the mechanical pressure to which it is subjected by a moderate degree of displacement, and it is indirectly affected by the greater difficulty of breathing, as well as by reflex irritation from the disordered stomach. All food which is liable to ferment in the stomach, such as sugar and indigestible starches and fats, must be particularly avoided. Gastric catarrh is readily excited and aggravated by coarse or fermenting food. On this account also the use of strong alcohol should be forbidden except in the case of aged and feeble persons, to whom light wine or diluted spirits may be given. The regular use of tobacco should be prohibited, and tea and coffee, if permissible, are to be taken only in very dilute form.
The tendency to constipation can be overcome by attention to diet, and a moderate amount of fruit, such as baked or stewed apples, stewed prunes, and grape fruit, may be allowed between meals.