The dietetic treatment in diseases of the heart has been the subject of much study, especially during the past few years.

The Diet.—In this pathological condition, as in many other diseases in which one or more of the functions of the body have become impaired, there can be no hard and fast rule covering the treatment or diet for all cases, but, as in nephritis, the condition of the individual, his symptoms, and the progress and extent of the disease must be taken into consideration in order to formulate a diet calculated to adequately nourish the body, while at the same time imposing the smallest amount of work with the least expenditure of labor upon the part of the diseased organ.

Division of Treatment.—The treatment of the disease then may be said to be divided into three stages: first, the stage of compensation; second, that of moderate compensation; third, that of decompensation. The diet is directed, first, toward relieving as far as possible the strain which is imposed more or less by all the food eaten; and second, keeping up the general nutrition of the body.

Dietetic Treatment.—No matter what has caused the impairment of the heart functions, the treatment must necessarily remain the same as far as diet is concerned. The patient is no longer able to handle a full and unrestricted diet. As long as compensation is good, the restrictions are scarcely noticeable; alcoholic beverages and possibly tobacco may have to be, to a certain extent, curtailed, and in some cases avoided altogether. However, if the individual desires to live and be comfortable while so doing, he must lead a wholesome, simple life, since he cannot with safety indulge in any excesses, either in diet or in any other particular.

Diet in Second Stage.—When the second stage sets in, that is, when the heart muscle is unable to perform its normal function, attention must be directed toward two main points; first, the work of the heart; second, the pressure upon that organ from other sources, namely, the stomach and intestines. As long as the food does not disagree, that is, so long as there is no fermentation or putrefaction of the food material in the stomach and intestines the flatulence arising from the evolution of gas in those organs is slight and the pressure upward upon the heart inconsiderable.

Restricting the Fluids.—The heart must be spared all unnecessary work. This can only be accomplished by limiting the amount of food and fluids ingested. The latter imposes an extra burden upon the impaired organ to eliminate. Consequently, the amount of fluid should be limited to 1500 c.c. a day at most, and in many cases considerably less than that quantity.

Regulating the Meals.—The meals should be small and the intervals of feeding regular. It has been found best to give the fluids between meals rather than with the food. In many cases of heart disease, as in certain nephritic conditions, edema is a prominent symptom, so that it is necessary to direct our efforts toward overcoming that particular condition. The Karell Cure[134] and the salt-poor diet are used with excellent results. The latter is not so low as the former, and in many cases will accomplish all that is required. A modified Karell diet is used in the Michael Reese Hospital[135] in Chicago as follows:

“MODIFIED KARELL TREATMENT”
(Salt-free)

“Milk 200 c.c. at 8 A.M., 12 M., 4 P.M., and 8 P.M., for five to seven days.

Eighth day—Milk same as above.

10 A.M. one soft egg; 6 P.M. 2 slices of dry toast.

Ninth day—Milk as above.

10 A.M. one soft egg and 2 slices of toast.

Tenth to twelfth day—Milk as above.

12 M. chopped meat, rice boiled in milk, easily digested vegetables.

6 P.M. one soft-boiled egg.

The diet is gradually increased until a full tray is reached. All meats and vegetables should be chopped or scraped at first, and the heavier foods should be given only when the heart is practically compensated.”

Rules and Regulations.—There are a few general rules which it has been found advisable to impress upon individuals suffering from a disease in which the muscles of the heart have become weakened. The compensation of the organ may improve, but there is still a danger of a reoccurrence or a further development more or less serious, and at times fatal. So for this reason, certain rules must be observed throughout life:

First: the necessity for keeping the meals small, simple, and digestible. Death at times occurs with symptoms of gastric disturbance, which is, after all, due to the heart. Consequently it is not wise to invite such disaster by overeating, or by the partaking of any food which is liable to bring about indigestion, either in the stomach or in the intestines. Most authorities advise four or five meals a day rather than the regulation three, and limit the fluids at meal time to a few ounces only, when any are allowed, and to a maximum amount of 1500 c.c. during the day, chiefly between meals.

Second: the need for limiting the amount and type of exercise taken, especially after eating, since the work of digestion requires all the power and strain of which the heart is capable, and since an additional tax placed upon it by muscular exertion might readily be just the final straw, the added fraction which weighs down the balance on the scale of life.

Third: the advisability of abstaining from alcoholic beverages, unless specially prescribed by the physician in charge.

Certain elderly people suffer from a condition known as senile heart, which is more or less associated with arteriosclerosis and high blood pressure. These individuals should be prevailed upon to take the precaution of regulating their habits of life, avoiding excesses of all kinds, not only on account of the weakened condition of the heart, but also on account of the condition of the arteries. They should avoid excitement and worry, since the very fact that they are worrying increases the blood pressure. Simple foods in limited quantities, five meals a day instead of three, and an avoidance of too much fluid, should be the keynote of their daily rÉgime.

Tact on the part of the nurse is necessary in all cases, both young and old. It is often more difficult to instill good dietary habits in heart patients, after acute symptoms have subsided, than to carry them out during the acute attack, when the life itself depends upon a rigid adherence to the diet prescribed. But as these rules and regulations are essential to the future welfare of the patient, he must be taught with care, and in such a way that he will not be alarmed to an extent when more harm than good will come of the teaching.

The diet should consist chiefly of milk, eggs, rare meat in moderation (mutton, chicken, fish, and oysters), well-baked bread, well-cooked cereals, potatoes and green vegetables, and simple desserts. All foods which in any way cause gastric or intestinal disturbances must be avoided. If these disturbances arise during the course of the disease, the patient should be promptly returned to the strict milk diet. When edema is prominent, it is treated as already described in the treatment for the like condition in nephritis by the Karell or salt-free diet.

The dietetic treatment given here is merely a guide to be used under certain conditions. The physician formulates the diet, and the nurse must understand what to expect and how to apply the treatment as the symptoms arise.

SUMMARY

Dietetic Treatment, adjusted to relieve the weakened heart muscles and to save the organ from all possible strain.

Three Stages, during which the treatment changes according to the extent and progress made by the disease.

First Stage: The diet is practically normal. Compensation is good, consequently no dietary measures save the limiting of alcoholic beverages are necessary.

Second Stage: The compensation is only moderate and the heart cannot perform its normal functions, hence the diet must be directed toward relieving any pressure upon the organs from other organs and toward lessening the work of the heart itself.

Third Stage: In which the compensation is decidedly impaired and for this reason the dietetic treatment undergoes a decided change.

Digestional Disturbances in which there is an evolution of gas in the stomach or intestines may cause a pressure against the heart which is distinctly bad for it.

Limiting the Fluids in the diet in heart disease is necessary when the compensation is only moderate, as they impose an extra burden upon the organ to eliminate them. Amount of Food must also be limited. The meals must be small and taken without fluid. The latter should be taken between meals.

Edema occurs in a number of cases and must be treated as in nephritic conditions by limiting the fluids and by confining the diet to “salt-poor” foods.[136]

Karell Cure or modification thereof has been used with good results in many cases of heart disease.

Exercise must be limited in amount and confined to types which will not impose a tax upon the weakened heart muscles. Exercise after eating is especially to be discouraged, as this, together with the efforts required for the digestion of food, might readily prove too much for the heart to accomplish.

Elderly Patients must be warned against exercises of all kinds, not only on account of the condition of the heart, but also on account of the condition of the arterial walls. These harden with age and break down under undue pressure.

The Nurse should instruct the patient on the points necessary for the saving of the heart. She should teach the necessity for keeping the meals small and having them more frequently if necessary; of limiting the fluids at meals to a few ounces or leaving them out altogether at this time. She should know how necessary is the reduction of the fluid. She should also warn against the taking of alcoholic beverages except with the permission and advice of a physician.

Excitement and Worry increase the blood pressure, hence must be avoided by individuals suffering with any form of heart disease.

PROBLEMS