OUR CHANGING VIEWPOINT ABOUT CONGESTIVE FAILURE

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Abstract
A discussion of evidence leading to the development of a new viewpoint concerning the genesis of congestive failure as seen in the clinic is presented. The approach is through an analysis of the factors causing venous congestion. The old conception, that venous congestion was the direct mechanical consequence of cardiac weakness and low cardiac output, has been disproved. Instead of such a simple and direct relationship the weakened heart initiates a train of events which leads to venous congestion. The following train is suggested: (1) Heart Disease, (2) diminished circulation to (a) kidney (b) bone marrow (c) endocrine organs, (3) retention of salt and water, (4) increased blood volume (5) venous congestion, (6) stimulation of heart through increased filling pressure, (7) further damage to the heart. The possibility that this train of events might be initiated by other things than heart disease is discussed at length. Thus diminution of renal circulation by renal lesions might initiate the train leading to congestive failure in certain cases of hypertension; anoxemia might initiate it and so account for the clinical picture of venous congestion with a high cardiac output found in some cases of chronic pulmonary disease; and fluid retention might be the first step in the venous congestion despite an abnormally high cardiac output, seen in beri-beri.