Nutrition and cardiac disease.

The relationship between undernutrition and cardiac dysfunction in the critically ill patient is cyclical and reinforcing. Increased awareness of the high coincidence of these two problems in the ICU should improve both diagnosis and treatment. Acutely, nutritional goals often must be limited to optimizing metabolic machinery. Repletion of protein and calorie deficiencies, which requires additional fluid loads, should be approached with caution. The potential hazards associated with alimentation necessitate careful monitoring during repletion, and although restoration of an anabolic state may improve myocardial function, this is unproved. In spite of this, the advantages conferred by a generally improved nutritional state are great, particularly for patients in the perioperative period. Therefore, alimentation with the intention of restoring lean body mass seems a worthwhile goal.