THE CARDIAC OUTPUT IN CONGESTIVE HEART FAILURE AND IN ORGANIC HEART DISEASE

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Abstract
Certain circulatory measurements were made on patients exhibiting (rheumatic, arterio-sclerotic, hypertensive, and syphilitic) organic heart disease. Organic heart disease in patients who have not experienced failure is associated with decrease in cardiac index (L/sq.m./ Min) and in cardiac output per beat. The cardiac output per min. (Grollman''s acetylene 3 sample technique) and cardiac output per beat are decreased further in the presence of congestive heart failure. As compensation is restored, there is increase in cardiac index and in cardiac output per beat. However, the values do not usually reach the level prevailing before the occurrence of failure. The venous pressure is usually elevated in congestive heart failure. The avg. circulation time (decholin) is prolonged in patients suffering from congestive heart failure and in those recovered from failure but the avg. value is normal in those who have not experienced failure. The arterio-venous O2 difference is increased slightly in organic heart disease, still more after recovery from failure and greater still in the presence of heart failure. The work of the heart per beat in relation to its size may be normal or show slight decrease in the presence of heart disease. In the presence of heart failure, there is a marked discrepancy between the size of the heart and its work. After recovery, the heart size-work relationship is restored toward the normal level. The foregoing evidence indicates that there is a marked decrease in the functional capacity of the heart as a pump in congestive heart failure and the size of the heart increases. Since the output per beat is decreased, and the heart size is larger, the work per beat is no longer commensurate with the size of the heart. With restoration of compensation, the functional capacity is increased toward a normal level but on the average does not attain the level of which it was capable before the onset of failure.