Pathogenesis of Congestive Heart Failure

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Abstract
Twenty- five compensated resting patients were given 12 to 24[mu]c RISA and serial arterial blood samples were obtained to determine control plasma volume, sodium, osmolality, hematocrit, blood lactate, and pyruvate. The patients were then exercised for ten minutes on a horizontal bicycle and then allowed to rest for 30 minutes. Blood samples were obtained at five and ten minutes of exercise and again at 30 minutes of rest. At five minutes, plasma volume decreased by 3.1%, sodium increased by 3.2 mEq/1, osmolality rose by 4.4 mOsm/l and hematocrit rose by 1.2 vol%. Blood lactate-pyruvate ratio, reflecting anaerobic metabolism, rose from 7.49 to 18.49. At ten minutes plasma volume was down by 3.7%, sodium rose by 3.8 mEq/l, osmolality rose by 3.2 mOsm/1, hematocrit rose by 1.3 vol% and lactate-pyruvate ratio rose from 7.49 to 15.82. Total sodium content changed very little indicating water and only water moved out of the plasma. Significant correlation was found between fall in plasma volume and relative increase in lactate-pyruvate ratio. The findings suggest that shift of water out of the plasma during exercise is probably caused by increased rate of anaerobic muscle metabolism which presumably increases the cellular osmolality. It is postulated that this phenomenon might play an important role in fluid retention by cardiac patients.

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