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Diet And Baths In Heart Disease
Source: Disturbances Of The Heart
The diet in cardiac diseases has already incidentally been referred
to. The decision as to what a patient ought to eat or drink must
often be modified by just what the patient will do, and, as we all
know, it is absolutely necessary to make some concessions in order
for him to aid us in hastening his own recovery or in preventing him
from having relapses. Consequently, we cannot be dogmatic with most
patients with chronic heart disease. Parents should be prohibited
from allowing children or adolescents with heart disease to drink
tea, coffee or any alcoholic stimulant. The young boy and young man
must absolutely be prohibited from indulging in tobacco at all.
There is no excuse for allowing these stimulants or foods in such
cases. If the patient is older and has been accustomed to tea and
coffee, one cup of coffee in the morning may be allowed, provided a
decaffeinated coffee is not found satisfactory. Whether a small cup
of coffee or a cup of tea is allowed at noon is again a matter for
individualization; they should rarely be allowed after the noon
meal. In a patient who has been accustomed to alcohol regularly
(generally an older patient), careful judgment should be used in
deciding whether or not a small amount of alcohol daily should be
allowed. It should never be in large amounts, even of a dilute
alcohol like beer; it may be a weak wine; it may be a small amount
of diluted whisky, if seems best. Ordinarily the patient is better
without it. If he is used to smoking and a small amount does not
raise the blood pressure much, it may do him no harm to smoke a
small mild cigar once or twice a clay. On the other hand, if a hard
smoker suddenly has heart failure, whether from exertion, from
chronic disease or from acute illness, a small amount of smoking is
of advantage as it tends to remove cardiac irritability, to raise
the blood pressure, and actually to quiet and improve the
circulation. It is unwise during acute circulatory failure to take
tobacco away entirely from a chronic tobacco user.
The character of the food which each patient should receive depends
on his blood pressure and his age. The older person with a tendency
to high blood pressure should have the protein (especially meat)
reduced in amount, as any putrefaction in the intestine with
absorption of products of such maldigestion irritates the blood
vessels, raises the blood pressure, and injuries the kidneys. On the
other hand, a young patient should receive a sufficient meat diet
rather than be overloaded with vegetables and starches, to the easy
production of fermentation and gas. Flatulence from any cause must
be avoided. It dilates the stomach and intestines, causing them to
press on the diaphragm, so that the heart and respiration are
interfered with. Also, an increased abdominal pressure, especially
if there is any edema or dropsy, is bad for the circulation. A
distended, tense abdomen is serious in cardiac failure. On the other
hand, a flaccid, flabby, lax abdomen should be well bandaged in
cardiac failure with low blood pressure.
Children do well on a milk diet, but it should be remembered that
excessive amounts of any liquid, even milk and water, are
inadvisable, if the circulation is poor and there is a tendency to
dropsy. It has been recommended at times to limit a patient's diet
for a week or so to a small amount of milk, not more than a quart in
twenty-four hours. If such a patient is in bed and does not require
carbohydrates, sugars or stronger proteins or more fat, such a
restricted diet may aid in establishing circulatory equilibrium,
although he will lose in nutrition. The excretory organs are
relieved by the decreased amount of excretory product, the digestive
system is rested and the circulation is improved. Such a limited
diet should not be tried longer than a week, but it may be the
turning point of circulatory improvement.
The ordinary diet for a convalescing heart patient should be small
in bulk, of good nutritive value, and should represent all the
different elements for nutrition. This means a small amount of meat,
once a day to older patients, twice a day to those who work hard or
for young patients; such vegetables as do not cause indigestion with
the particular patient, and these must be individualized; such
fruits as are readily digested, especially cooked fruits; generally
plenty of butter, cream, olive oil if the nutrition is low, and
milk, depending on the age of the patient or the ease with which it
is digested. Soups, on account of their bulk and low nutritive
value, should be avoided. Anything that causes indigestion, such as
fried foods, hot bread, oatmeal or any other gummy, sticky,
gelatinous cereal should be avoided; also spices, sauces and strong
condiments. Anything that is recognized as especially loaded with
nuclein and xanthin bodies, such as liver, sweetbreads and kidneys,
should be prohibited, as tending to cause uric acid disturbance; and
the more tendency to gout or uric acid malmetabolism the more
irritated are the arteries and the more disturbed the blood
pressure. Sugars should be used moderately unless the patient is
thin and feels cold, in which case more may be given, provided there
are no signs of gout or disturbed sugar metabolism. Sugar is at
times a good stimulant food. Very cold and very hot drinks or food
should be avoided.
Many times these patients have a diminished hydrochloric acid
secretion, and such patients thrive on 5 drops of dilute
hydrochloric acid in water, three times a day, after meals. When
their nutrition has improved and the digestion becomes perfect,
hydrochloric acid will generally be sufficiently secreted and the
medication may be stopped.
If the patient is overweight, this obesity must be reduced, as
nothing more interferes with the welfare of the heart than
overweight and overfat. In these cases the diet should be that
required for the condition. If there are edemas, or a tendency to
edemas, the decision should be made whether salt (sodium chlorid)
should be removed from the diet. Unless there is kidney defect,
probably it need not be omitted, and a long salt-free diet is
certainly not advisable. This salt-free diet has been recommended
not only in nephritis and heart disease, but also in diabetes
insipidus and in epilepsy. It is of value if there is edema in
nephritis; it is of doubtful value in heart disease; it is rarely of
value in diabetes insipidus; and in epilepsy its value consists
probably in allowing the bromid that may be administered to have
better activity in smaller doses, the bromin salt being substituted
in the metabolism for the chlorin salt.
Next: The Resort Treatment Of Chronic Heart Disease