Diet And Baths In Heart Disease


Categories: Uncategorized
Sources: 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.





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