Cardiac venous congestion; its causes and consequences

Studies in hemodynamics and hypertension

This review covers a representative sampling of investigations in hemodynamics and hypertension performed by the author during the period from approximately 1945 to 1980. The hemodynamic studies included a description of changes associated with congestive heart failure and with acute myocardial infarction. These studies emphasized for the first time the importance of left ventricular afterload and of the mobilizable venous reservoir. Other hemodynamic studies included diverse subjects such as the first and only recordings of pulse waves in arteries as small as 200 gammam in diameter, velocity differences between red blood cells and plasma, turbulent blood flow in the ascending aorta, increase in velocity of blood flow of leg veins under compression, rates of transcapillary flow of solutes in humans, and the first use of external arterial pulse wave recordings to assess vascular compliance. Pioneer studies in hypertension included the first use of an antihypertensive drug to treat malignant hypertension and the first report of the treatment of hypertension with a thiazide diuretic.

Cardiovascular dynamics, blood volumes, renal functions and electrolyte excretions in the same patients during congestive heart failure and after recovery of cardiac compensation

Largely on the basis of acute observations in cardiac patients during congestive heart failure and in noncardiac control subjects, two assumptions have been made: (a) that congestive heart failure develops as cardiovascular and renal functions change from the type found in the control subjects to the type found in decompensated cardiac patients, and (b) that a return to, or toward, the normal occurs in these functions as cardiac compensation is regained. That these assumptions are not necessarily valid is indicated by the herein reported simultaneous measurements of cardiovascular dynamics, renal functions, blood volumes and electrolyte excretions in eight patients during cardiac decompensation and after recovery of compensation.

Experimental Hypervolemic Heart Failure: Its Bearing on Certain General Principles of Heart Failure

Infusion of large volumes of fluid into normal dogs produces a progressive rise in venous pressure with an initial parallel rise in cardiac output succeeded by a fall. On the basis of these experiments and other considerations which are discussed, it is concluded that the cardinal hemodynamic defect common to all types of heart failure is a disproportion between inflow load and cardiac output. The various general circulatory disorders are classified as primary disorders of filling and primary disorders of emptying with various subgroups.