Causes

Asthenia arises from such lesions of the myocardium as pericarditis, chronic myocarditis, fatty degeneration and infiltration, from chronic and often progressive cardiac and aortic lesions, such as chronic valvular diseases of the heart, arteriosclerosis, and atheroma of the aorta, and from malnutrition such as will be caused by prolonged and high fevers and profound anemias. Many of these causative lesions cannot be removed, while some of them tend to grow gradually worse when once established. So long as the heart can be kept strong enough to do its work, these lesions do not affect the general health of the person in whom they have developed; or if a weak heart can be strengthened, so that its work may be resumed, a degree of recovery is effected and permanent weakness is averted. For all these cardiac maladies treatment is addressed to the preservation of muscular strength or to the improvement of the nutrition of the heart. The treatment of cardiac weakness is, therefore, the chief, usually the whole, treatment of chronic heart diseases.

Frequently overexertion, either mental or physical, indigestion, constipation, or slight acute maladies give rise to the symptoms of cardiac fatigue, such as rapid heart-action or dyspnea, or both. This condition may be treated successfully and good compensation restored, provided the underlying lesion is not a progressive one. In other cases quick beating of the heart is constant, breathlessness is persistent, or at least is produced by exertion, and there are symptoms of passive congestion of certain organs, or edema, and often both. These are cases in which the heart muscle is exhausted. Anemia is a frequent and serious complication of both groups of cases. Treatment

When compensation for a valvular or other lesion is perfect, no special dietetic treatment is needed, unless the lesion is a progressive one, as when aortic valvular lesions grow out of aortic atheroma, or a stenosis exists that is likely to become by degrees more pronounced. Moderation in diet, both quantitatively and qualitatively, the choice of nutritious foods, the avoidance of alcohol, tobacco, and indigestibles, especially such as lobster, crab, and the like, that throw an undue burden on the depurative function of the liver, will prolong the period of maintained compensation. Milk should form a large proportion of the dietary, and water in sufficient quantity to maintain good diuresis is necessary. The use of tea or coffee is usually to be avoided, but in individual cases may be permissible or even useful. When there is a progressive lesion, all physical overexertion must be avoided. Indigestion must be averted by scrupulous care in regard to eating. If gastritis exists, it must promptly be relieved. Fluids must be taken in moderation, and the bowels carefully regulated. At the same time, however, a nutritious diet is necessary, as there is often a tendency to malnutrition of the heart muscle.

When arteriosclerosis and atheroma are the causative lesions of asthenia, all irritating foods and drinks, such as rich meats, rich gravies and sauces, and alcoholic beverages, must positively be forbidden. In such cases the kidneys are usually not sound, and elimination of nitrogenous waste is lessened; therefore a modified milk diet is the best. Not only is milk an important aliment, because it does not foster abnormal fermentations in the alimentary tract or produce renal or arterial irritants after digestion, but likewise is it an important diuretic, promoting the elimination of waste that otherwise would affect both arteries and muscles deleteriously. Milk, therefore, must be the staple food, although simply cooked vegetables, fruits, and stale breads are also permissible and commendable. Such vegetables, however, as boiled cabbage, cauliflower, and baked beans, which digest slowly and are liable to cause flatulence, should be avoided. If the cereals do not cause the same disturbance, they may be eaten. In the cases in which the arterial and cardiac lesion is trifling, soft-boiled and poached eggs, fish, and oysters, rarely squab or the breast of chicken, may be permitted in small amounts and not oftener than once daily or once in two days.

When compensation is broken and the symptoms of cardiac fatigue are manifest, the indications for treatment are to lessen the work that the heart has to do, and to improve its strength. Food judiciously administered may be made to meet both indications. Rest, or graduated exercise, fresh air, sunshine, sometimes hydrotherapy and medicinal tonics, are also needed.

From what has already been said of the treatment of cardiac diseases, it is evident that in this group of cases digestive disorders must be prevented or corrected and an excess of fluids must be avoided in order not to tax the heart with an unnecessary amount of work. It is equally essential that beverages shall not be taken in too small quantities, for if they are, blood pressure will be lessened too much and the heart will not work advantageously unless its muscle is stretched to some extent. This renders the use of a dry diet inadvisable, and indicates the moderate use of fluids. Only easily digested foods should be eaten; therefore fats, fried foods, pastries, hot breads, pancakes, cakes, entrees, stews, rich sauces, and very sweet foods must be avoided. Moreover, only small portions of food should be eaten at a time, for overindulgence is especially harmful. A variety of simply prepared and easily digested food should be prescribed. Milk, kumiss, buttermilk, chicken, tender lean meat, oysters, eggs, stale bread, pulled bread, crackers, baked potato, peas, spinach, lettuce, oranges, and fruit jellies constitute a safe variety of food for the mild cases and for those which may be improving.

Sometimes in this stage of heart weakness, but more frequently in the next, when the heart is exhausted, a chronic catarrh of the stomach complicates the ailment. Then the dietetic treatment appropriate for gastritis must be maintained. A milk diet, or slightly modified milk diet, is often at first the best. It may be gradually modified as the gastrir disorder lessens. It must be remembered that, as a rule, in cardiac diseases when the heart is weak, digestion is also impaired; therefore the stomach, intestines, and liver must not be taxed unduly. Their strength must be preserved, well-digested and easily absorbed food being necessary to maintain cardiac and general vigor. When the heart is exhausted, a variable degree of passive congestion of the alimentary tract and liver exists. This interferes with the prompt absorption of digested foods and diminishes glandular secretion or the formation of digestive juices. Indigestion is, therefore, easily brought on, and is a complication in almost every case in greater or less degree. What has just been said of the exclusive use of easily digested foods, in moderate or small quantities, and of the avoidance of indigestible ones, is doubly applicable to such cases. If the liver is congested and comparatively inactive, sweets, excessive quantities of starches, and the red meats should be avoided or used with great moderation.