Patients with
cardiac disease can develop two types of
malnutrition: cardiac
cachexia, which appears in chronic
congestive heart failure, and
malnutrition due to the complications of cardiac surgery or any other type of surgery in patients with
heart disease. Early
enteral nutrition should be attempted if the oral route cannot be used. When cardiac function is severely compromised,
enteral nutrition is feasible, but supplementation with
parenteral nutrition is sometimes required. Sustained
hyperglycemia in the first 24 hours in patients admitted for
acute coronary syndrome, whether diabetic or not, is a poor prognostic factor for 30-day mortality. In
critically-ill cardiac patients with stable hemodynamic failure,
nutritional support of 20-25 kcal/kg/day is effective in maintaining adequate nutritional status.
Protein intake should be 1.2-1.5 g/kg/day. Routine polymeric or high
protein formulae should be used, according to the patient's prior nutritional status, with
sodium and volume restriction according to the patient's clinical situation. The major energy source for myocytes is
glutamine, through conversion to
glutamate, which also protects the myocardial cell from
ischemia in critical situations. Administration of 1 g/day of omega-3 (EPA+DHA) in the form of
fish oil can prevent
sudden death in the treatment of
acute coronary syndrome and can also help to reduce hospital admission for cardiovascular events in patients with chronic
heart failure.