General Introduction

It is probably no exaggeration to say that the majority of patients who complain of their heart are really suffering from a derangement of the stomach or liver, which has had its origin in dietetic errors. This will emphasise to the reader the very important relationship which exists between the stomach and the heart, and at the same time will indicate the great importance of diet in the prevention and curative treatment of various cardiac disorders. Cardiac diseases are divided into two great groups, functional and organic. In the former there is a temporary derangement of the nervous and muscular mechanism of the heart; if there is any change in the structure of the heart, it is of a curable character. In the latter there is definite organic disease of the valves of the heart, or of the heart muscle. This is incurable; but when the tone of the heart is restored all the symptoms of the condition may disappear.

Organic disease may be acute or chronic. The acute diseases comprise inflammation of the covering of the heart (pericarditis), and of the lining membrane of the heart (endocarditis), both of which are usually due to the poison of rheumatism, scarlet fever, or Bright's disease. The chronic diseases are the result of a chronic inflammation or degeneration of the valves of the heart or of the heart muscle. These may be the sequel to acute disease; more commonly they are the result of a primary degenerative change due to the poison of gout, alcohol, rheumatism, Bright's disease, arterial sclerosis, syphilis, and influenza. A particular type of chronic organic disease is known as the senile heart; this results from a fatty or a fibroid degeneration of the heart muscle in elderly subjects. A considerable amount of organic disease of the heart may be present without inducing symptoms, and it is only when the heart begins to fail that definite symptoms of heart mischief are manifested.

Three cardinal features of heart disease are breathlessness, precordial discomfort or pain (angina), and palpitation. These are characteristic both of functional and organic disease, but are often most pronounced in functional disorders. In organic disease of the heart, symptoms may be few or absent, so long as the heart has been able to adapt itself by hypertrophy of muscle to the increased strain upon it; in other words, so long as compensation is established. There comes a time, however, when the compensatory mechanism fails, the heart muscle gives out, and the heart dilates, with the result that breathlessness, weakness, and other symptoms develop in proportion to the degree of dilatation. If this dilatation of the heart is very marked - in other words, if there is a complete failure of compensation - it induces a pronounced venous congestion of the vessels of the stomach, liver, kidney, and lungs, with resulting gastric catarrh, deranged digestion, albuminuria, and bronchitis. The question of diet becomes one of very great importance in these cases.

Functional Heart Derangements

As already indicated, the leading symptoms of functional disorder of the heart are precordial discomfort or pain, palpitation, and breathlessness. The more common causes of these derangements may be summarised as follows: -

1. Errors in diet - over-eating; hurried meals; excessive use of tea and alcohol.

2. Indigestion due to slight catarrh of the stomach or congestion of the liver, usually arising from an injudicious dietary, and more especially the too great use of starchy foods.

3. Nervous disorders, especially neurasthenia and hysteria.

4. Anemia and debility.

5. Extraneous poisons, e.g. tobacco and drugs.

We are only here concerned with the dietetic treatment of those cases which fall into the first two groups.

The first essential in the treatment of these cases is to ascertain in what way the dietetic habits of the individual have been at fault. It may be that the patient has been in the habit of taking five or six meals a day, tea and starchy foods bulking very largely in the dietary. Irregularity of meal hours and hurried meals are responsible in other cases. Constipation is an important predisposing factor, and worry is often a contributory cause. These defects must, so far as possible, be got rid of. As a rule, no special system of diet is called for. If the above points are kept in view, three simple meals a day will speedily cure the condition.

Acute Heart Disease - Acute Pericarditis And Endocarditis

These are acute febrile disorders, and the diet is essentially the diet of the febrile state. The most common cause of these affections is the poison of acute rheumatism, which induces rheumatic fever. The diet at the outset should be an exclusive milk diet. From 3 to 4 pints of milk should be given in the twenty-four hours, diluted one-third or more with plain water or potash. This should be given in the form of 8 to 10 ounces every two hours. Abundance of fluid is essential to promote fluidity of the blood, sweating, and free diuresis. The patient should, therefore, be encouraged to make free use of alkaline drinks, 1 pint or more of plain water or potash or soda-water being taken at intervals in the twenty-four hours. If milk is not well taken, it may be peptonised, or it is sometimes well borne if citrate or bicarbonate of soda are added to it in the proportion of 2 to 3 grains to the ounce. In cases where there is a marked intolerance to the milk, we must have recourse to beef-teas and meat essences. These should not be strong, but may have their nutritive value increased by the addition of some protein food. Further details, with appropriate dietaries, will be found in the chapter dealing with acute fevers.

If .stimulants are necessary, brandy and champagne are probably the most useful. These should be given in doses of 1/2 and 1 ounce of brandy, or I and 2 ounces of champagne, once or twice daily.