THE MECHANISM OF THE INCREASED VENOUS PRESSURE WITH EXERCISE IN CONGESTIVE HEART FAILURE*†

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Abstract
The peripheral venomotor and venous pressure responses to exercise of patients with congestive heart failure were studied. Venous distensi-bility of the forearm was measured with a plethysmograph during exercise of the legs. Constriction of the veins and a concomitant rise of venous pressure occurred with exercise in these patients. The responses to exercise were interrupted by a sympathetic ganglioplegic agent. Forearm venoconstriction occurred despite arterial occlusion of the exercising legs. The venoconstrictor response to the same exercise was not observed in compensated patients. These experiments lead to the hypothesis that in congestive heart failure excessive venous pressure during exertion occurs primarily as a result of constriction of the veins. This constriction of veins is mediated by a sympatho-adrenal discharge. These results are opposed to the concept that excessive flow of blood into the venous system with inadequate removal of this blood by the handicapped heart results in elevated blood pressure within the veins.