The main tasks of rehabilitation after heart attack и stenting are the restoration of the vital functions of the patient and reducing the risk of a recurrence. The success of rehabilitation measures is largely determined by the correctness of therapeutic nutrition. Diet in case of myocardial infarction is directed to:
- normalization of cardiac muscle function and acceleration of reparative processes in the myocardium;
- reducing the load on the cardiovascular system and improving blood circulation in general;
- stabilization of body weight in the presence of obesity;
- normalization of the motor function of the gastrointestinal tract.
The main principles of feeding post-infarct patients are:
- reduction in the consumption of fats (especially foods containing large amounts of saturated fatty acids);
- increase in the intake of polyunsaturated fatty acids, which reduce the level of lipids in the blood;
- free liquid limitation;
- increasing the intake of foods containing complex carbohydrates and fiber;
- restriction of table salt to 3-5 g per day;
- decrease in the diet of the share of foods rich in cholesterol.
Health food after myocardial infarction is built on the basis of dietary nutrition. The diet contains a physiologically normal amount of protein – 80-90 g (60% of animals), a limited fat content – up to 70 g fat (mostly animal) and 350-400 g carbohydrates (of which about simple carbohydrates account for about 30 g) consumption of table salt is not more than 3-5 g per day. The energy value of the diet is 2300-2400 kcal. The amount of free liquid at the level of 1,2 l / day.
The diet is enriched Vitamins A, С, Д and water-soluble vitamins that improve metabolic processes in the myocardium, which is achieved by including in the diet of the optimal amount of vegetable fat, fresh vegetables and fruits, some cereals (buckwheat, oatmeal), some meat products (veal).
In order to normalize the electrolyte composition of the extracellular / intracellular fluid, which is of great importance in the disturbance of myocardial metabolism, foods containing high amounts of potassium are introduced into the diet. This is achieved by including in the diet of patients with fruits and vegetables, juices and decoctions of them. To improve the contractile function of the heart, calcium is important, which enters the body with dairy products and whose presence in the diet is mandatory, especially if the heart attack was extensive.
Other trace elements (manganese, magnesium, potassium, iodine), necessary for the normal functioning of the heart muscle, are compensated by the presence in the diet of various products of vegetable and animal origin, in particular, various seafood (squid, mussels, shrimp, sea kale). To reduce the burden on the cardiovascular system Table 10I provides fractional 5-6-single power with the last reception for 3 hours before night sleep.
From the diet exclude all products that have an exciting effect (coffee, tea, chocolate, spices, cocoa). The specific weight of products containing dietary fiber (vegetables, cereals, fruits) is increasing, used in the form of salads or independent dishes. It is shown to include in the diet different varieties of “white” fish, because unsaturated fatty acids of fish fats improve the metabolism cholesterol. In order to normalize the function of the gastrointestinal tract from the diet, it is difficult to digest foods that promote fermentation in the intestine and cause flatulence, as well as extractives of meat and fish products.
Dietary nutrition after a heart attack for men and women is built depending on the stage of rehabilitation:
- Stage I – an acute period (the first week after a heart attack) – food is gentle (cooked by steaming or boiled with rubbing), with the exception of table salt. Eating 6-7 once a day, in small portions. The total weight of the daily ration 1700 g. Energy value of the diet 1100-1300 kcal, with the content of proteins, fats and carbohydrates in the amount of – 60, 30 and 180 g; free liquid – up to 0, 8 l. The menu can include: the first dishes on vegetable broth with mashed vegetables and cereals; steam cutlets, meatballs from low-fat beef, wiped cottage cheese, omelet from proteins, boiled low-fat fish of white varieties, crackers (up to 50 g), low-fat kefir; mashed potatoes from boiled beets, carrots, or potatoes, oatmeal or buckwheat porridge, mashed with milk; liquid jelly, jelly, fruit drinks, broth of wild rose, infusion of dried apricots, prunes or raisins; weak tea with the addition of milk, diluted with fruit water, carrot juice, alkaline still mineral water (without gas). All dishes should be warm, creamy and refined and vegetable oil added only to ready meals.
- Stage II – for acute period (2-3 week after infarction) – weight of daily ration no more than 2000 g. Energy value 1600-1800 kcal with protein, fat and carbohydrate content – 80: 50 and 200 d. Free liquid at level 0,8 l, the content of salt is not higher than 3. The dishes are steamed, stewed or boiled. Dishes are served in a crushed form fractionally, up to 6 once a day. The menu can include soups on vegetable broth with the addition of well-boiled cereals / vegetables, chopped boiled pieces of low-fat meat / fish, minced meat, unsalted low-fat cheese, mashed potatoes, carrots, beets, curd-fruit puddings; Baked apples, kefir, viscous, not mashed porridges (buckwheat, semolina), biscuits or dried wheat bread to 150 g; dishes from cauliflower, fruit and milk jelly, compotes and fruit drinks, raw soft fruits without coarse fiber, sugar to 50 g, weak tea. Vegetable refined and butter (up to 5 g), milk is added only to ready meals or sauces.
- Stage III – period of scarring (4 week) – weight of daily ration no more than 2300 g. Energy value 2100-2300 kcal with protein, fat and carbohydrate content – 90: 70 and 320. Food is boiled, stewed and served with a piece or chopped , 5 once a day. Free liquid at the level of 1 l, the amount of table salt is not more than 5 g / day. In the menu, you can turn on breadcrumbs or dried wheat bread to 150 g, first courses, on low-fat skimmed meat or vegetable broth, lean ham, boiled fish and meat, boiled pasta with cottage cheese, ripe tomatoes, curd puddings with the addition of fruits and cereals, stewed beets with carrots, butter – only in dishes (up to 10 g).
Diet after a heart attack for a man / woman with “extra” weight provides for its reduction in order to reduce physical stress on the myocardium and normalize lipid metabolism. This is achieved by holding unloading days in the form of:
- watermelon day 1500 g ripe watermelon on 5 receptions;
- rice-compote day (1 l compote and 100 g rice porridge);
- 800 ml of fruit juice and 500 g oatmeal for the day;
- apple day (2 kg of baked or wiped apples per day).
The terms for finding one or another stage of rehabilitation may be prolonged, especially after extensive myocardial infarction, in the presence of complications. The diet after the scarring stage consists of the minimum content of fats and salt.
In the presence of a patient who has had a myocardial infarction, circulatory insufficiency or arterial hypertension, can be assigned potassium diet, which has a diuretic effect, normalizes sodium-potassium metabolism, improves the state of the myocardium, lowers blood pressure. In the diet of the potassium diet, foods containing a lot of potassium and sodium-poor are included (the ratio of these micronutrients should be from 8: 1 to 14: 1).
In the daily diet, the potassium content should vary within 5-7 g, which is ensured by the inclusion of baked potatoes, dried apricots, raisins, dog-rose, nuts, and cabbage in the diet; veal, milk, low-fat cottage cheese, vegetable oil, citrus, oats, barley and wheat cereals; prunes, gooseberries, black currants. There are four variants of the potassium diet, differing in their chemical composition and potassium content. Given that the diet is physiologically inferior, it is prescribed for a short time at 3-5 days, and as the patient’s condition improves, Diet 10I.
Postponed myocardial infarction and other manifestations of acute coronary insufficiency in the period of rehabilitation of the patient.
To minimize the risk of complications in the diet, you must include foods rich in polyunsaturated fatty acids, fiber and complex carbohydrates. The menu includes soups on vegetable broth with the addition of well-boiled cereals and potatoes (cabbage soup, borsch). For lean dishes, low-fat varieties of white fish (hake, cod, tuna, flounder) and seafood (prawns, mussels, squid, sea kale) are extremely useful, as well as lean red meat and dietary poultry (turkey, chicken), rabbit in boiled or baked, chopped or chopped. Vegetable refined oils (sunflower, olive) and fatty fish are recommended as fats: sardines, herring, tuna, salmon (salmon, chum, pink salmon).
The ration includes unsalted cheeses with low fat content, skim milk products (kefir, fermented milk). Bakery products in the diet are present in the form of products from whole grains, coarse flour, unleavened bread, oatmeal cookies. The volume of fruits and vegetables consumed in any form and manner of cooking, as well as freshly squeezed berries (blackberries, strawberries, blueberries) and fruits, walnuts, are increasing.
It is extremely useful to use fresh greens, dishes from cereals. To improve blood circulation, it is necessary to include decoctions of rose hips and wheat bran in the diet. The parameters of lipid metabolism are favorably influenced by the drinking of mineral waters, predominantly hydrocarbonate sodium, chloride, sulfate or water of mixed cationic composition.