The Role of Anaerobic Metabolism in the Performance of Mild Muscular Work. I. Relationship to Oxygen Consumption and Cardiac Output, and the Effect of Congestive Heart Failure1

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Abstract
Rates of O2 consumption do not accurately measure the degree of exertion in human subjects performing work, and the error is systematically greater in patients with circulatory diseases than in normal subjects. Estimates of molecular O2 concentrations in body fluids, or their rates of exchange do not serve to indicate whether O2 supply is adequate to meet the tissue requirements of the moment. A basic physiologic derangement in all patients with congestive heart failure is an inadequacy of O2 supply rates to meet tissue energy requirements, an inadequacy which is specifically due to insufficiency of cardiac response, but which is neither indicated nor measured by the observed changes in O2 delivery or cardiac output.