Pathogenesis of Congestive Heart Failure
Authors: LLOYD T. ISERI
Journal: Annals of Internal Medicine (1961)

Article1 September 1961Pathogenesis of Congestive Heart FailureEffect of Posture and Exercise on Plasma Volume and Plasma ConstituentsLLOYD T. ISERI, M.D., F.A.C.P., ETELE L. BALATONY, M.D., JOHN R. EVANS, M.D., MILTON G. CRANE, M.D.LLOYD T. ISERI, M.D., F.A.C.P., ETELE L. BALATONY, M.D., JOHN R. EVANS, M.D., MILTON G. CRANE, M.D.Author, Article, and Disclosure Informationhttps://doi.org/10.7326/0003-4819-55-3-384 SectionsAboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissions ShareFacebookTwitterLinkedInRedditEmail ExcerptThe exact mechanism of sodium and water retention in congestive heart failure remains obscure despite the fact that hemodynamic, circulatory, renal, and endocrine factors have been studied extensively. Metabolic studies (1-7) have suggested that certain changes occur in the tissue cells which might be responsible for the ultimate accumulation of salt and water. Electrolyte studies of the plasma in heart failure (8, 9) have concurred indirectly with the hypothesis that circulatory insufficiency produces increased cellular osmolality. In view of these changes, further study of the effect of circulatory stress on the extracellular compartment seemed to be indicated.The effect of...References1. ISERIBOYLEMYERS LTAJGB: Water and electrolyte balance during recovery from severe congestive failure on a 50 milligram sodium diet. Amer. Heart J. 40: 706, 1950. CrossrefMedlineGoogle Scholar2. SQUIRESCROSLEYELKINTON RDAPJR: The distribution of body fluids in congestive heart failure. III. Exchanges in patients during diuresis. Circulation 4: 868, 1951. CrossrefMedlineGoogle Scholar3. MILLER GE: Water and electrolyte metabolism in congestive heart failure. Circulation 4: 270, 1951. CrossrefMedlineGoogle Scholar4. MADERMORITAISERI IJYLT: Sodium, potassium and magnesium balance during recovery from congestive heart failure due to cor pulmonale and other heart diseases. Circulation 12: 1057, 1955. CrossrefMedlineGoogle Scholar5. FARBERSABERMAN SJRJ: Total body water and total exchangeable sodium in edematous states due to cardiac, renal, or hepatic disorders. J. Clin. Invest. 35: 779, 1956. CrossrefMedlineGoogle Scholar6. FABREPLATTNERDUCHESKT-MAULBETSCH JHCA: The electrolyte metabolism in heart failure. Exploration of the intracellular compartment. Arch. Mal Coeur 45: 903, 1952. MedlineGoogle Scholar7. ISERIUHLCHANDLERBOYLEMYERS LTHSDEAJGB: Fluid and electrolyte balance during recovery from high-output heart failure due to beri-beri. Circulation 9: 247, 1954. CrossrefMedlineGoogle Scholar8. ISERIMADERBOYLE LTIJAJ: Electrolyte studies in heart failure. II. Extracellular factors in the pathogenesis of congestive edema. Circulation 11: 620, 1955. CrossrefMedlineGoogle Scholar9. ISERIMCCAUGHEYALEXANDERBOYLEMYERS LTRSLAJGB: Plasma sodium and potassium concentrations in congestive heart failure. Relationship to pathogenesis of failure. Amer. J. Med. Sci. 224: 135, 1952. CrossrefMedlineGoogle Scholar10. DEPAIVA E: Exercise tolerance and its relation to the heart and blood volumes. Gaz. Med. Port. 10: 347, 1957. MedlineGoogle Scholar11. EBERTSTEAD RVEA: Demonstration that in normal man no reserves of blood are mobilized by exercise, epinephrine, and hemorrhage. Amer. J. Med. Sci. 201: 655, 1941. CrossrefGoogle Scholar12. KALTREIDERMENEELY NLGR: The effect of exercise on the volume of blood. J. Clin. Invest. 19: 627, 1940. CrossrefMedlineGoogle Scholar13. MITCHELLSPROULECHAPMAN JHBJCB: Factors influencing respiration during heavy exercise. J. Clin. Invest. 37: 1693, 1958. CrossrefMedlineGoogle Scholar14. THOMPSONTHOMPSONDAILEY WODKME: The effect of posture upon the composition and volume of the blood in man. J. Clin. Invest. 5: 573, 1928. CrossrefMedlineGoogle Scholar15. WATERFIELD RL: The effect of posture on the circulating blood volume. J. Physiol. 72: 110, 1931. CrossrefMedlineGoogle Scholar16. WATERFIELD RL: The effect of posture on volume of the leg. J. Physiol. 72: 121, 1931. CrossrefMedlineGoogle Scholar17. HAMILTONMORGAN WFAB: Mechanism of the postural reduction in vital capacity in relation to orthopnea and storage of blood in the lungs. Amer. J. Physiol. 99: 526, 1932. CrossrefGoogle Scholar18. LAGERLÖELIASCHWERKOBERGLAND HHLE: Orthostatic changes of the pulmonary and peripheral circulation in man. Scand. J. Clin. Lab. Invest. 3: 85, 1951. CrossrefMedlineGoogle Scholar19. CHAPLINMOLLISONVETTER HPLH: The body/venous hematocrit ratio: its constancy over a wide hematocrit range. J. Clin. Invest. 32: 1309, 1953. CrossrefMedlineGoogle Scholar20. LUETSCHERCURTIS JARH: Observations on aldosterone in human urine. Fed. Proc. 14: 746, 1955. MedlineGoogle Scholar21. GOWENLOCKMILLSTHOMAS AHJNS: Acute postural changes in aldosterone and electrolyte excretion in man. J. Physiol. 146: 133, 1959. CrossrefMedlineGoogle Scholar22. BROWNHOPPERSAMPSONMUDRICK EJJJC: The loss of fluid and protein from the blood during a systemic rise of venous pressure produced by repeated Valsalva maneuvers in man. J. Clin. Invest. 37: 1465, 1958. CrossrefMedlineGoogle Scholar23. KATTUSSINCLAIR-SMITHGENESTNEWMAN AABJEV: The effect of exercise on the renal mechanism of electrolyte excretion in normal subjects. Bull. Johns Hopkins Hosp. 84: 344, 1949. MedlineGoogle Scholar24. RANKE J: Tetanus, Eine physiologische Studie. Cited by FLETCHER, W.: The osmotic properties of muscle and their modifications in fatigue and rigor. J. Physiol. 30: 414, 1904. Google Scholar25. COOKE E: Experiments upon the osmotic properties of living frog's muscle. J. Physiol. 23: 137, 1898. CrossrefMedlineGoogle Scholar26. FLETCHER W: The osmotic properties of muscle and their modifications in fatigue and rigor. J. Physiol. 30: 414, 1904. CrossrefMedlineGoogle Scholar27. BARCROFTKATO JT: Effects of functional activity in striated muscle and the submaxillary gland Phil. Trans. Roy. Soc., London, 1915, 207 (B), 149. Google Scholar28. LAZARUS-BARLOW WS: The pathology of the oedema which accompanies passive congestion. Phil. Trans. Roy. Soc., 1894, London, 1895, 185 (B), 779. Cited by MOORE, A. R.: Cryoscopic measurement of the osmotic difference between resting and fatigued muscle. Amer. J. Physiol. 41: 137, 1916. Google Scholar29. STARKWEATHER EV: On the volume changes of the arm during muscular exercise. Univ. Calif. Publ. Physiol. 4: 187, 1913. Google Scholar30. BACKCOGANTOWERS MKMAE: Functional oedema in frog's muscle. Proc. Roy. Soc. 88: 544, 1915. Google Scholar31. SCOTTHERMANNSNELL FHETAH: Factors influencing the interchange of fluid between blood and tissue spaces. Amer. J. Physiol. 44: 313, 1917. CrossrefGoogle Scholar32. MOORE AR: Cryoscopic measurement of the osmotic difference between resting and fatigued muscle. Amer. J. Physiol. 41: 137, 1916. CrossrefGoogle Scholar33. WELTORLOFFKYDDOLTMAN LGJDMJE: An example of cellular hyperosmolarity. J. Clin. Invest. 29: 935, 1950. CrossrefMedlineGoogle Scholar34. ISERIBOYLECHANDLERMYERS LTAJDEGB: Electrolyte studies in heart failure. I. Cellular factors in the pathogenesis of edema of congestive heart failure. Circulation 11: 615, 1955. CrossrefMedlineGoogle Scholar35. ISERIALEXANDERMCCAUGHEYBOYLEMYERS LTLCRSAJGB: Water and electrolyte content of cardiac and skeletal muscle in heart failure and myocardial infarction. Amer. Heart J. 43, 215, 1952. CrossrefMedlineGoogle Scholar36. JAENIKEWATERHOUSE JRC: The nature and distribution of cardiac edema. J. Lab. Clin. Med. 52: 384, 1958. MedlineGoogle Scholar37. HUCKABEEJUDSON WEWE: 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 failure. J. Clin. Invest. 37: 1577, 1958. CrossrefMedlineGoogle Scholar38. LEWISBUIESEVIERHARRISON JMRMSMTR: The effect of posture and of congestion of the head on sodium excretion in normal subjects. Circulation 2: 822, 1950. CrossrefMedlineGoogle Scholar39. BARGERMULDOWNEYLIEBOWITZ ACFPMR: Role of the kidney in the pathogenesis of congestive heart failure. Circulation 20: 273, 1959. CrossrefMedlineGoogle Scholar40. VERNEY EB: Croonian Lecture. The antidiuretic hormone and the factors which determine its release. Proc. Roy Soc. 135: 25, 1947. Google Scholar This content is PDF only. To continue reading please click on the PDF icon. Author, Article, and Disclosure InformationAffiliations: Downey, CaliforniaReceived for publication February 10, 1961.From the Rancho Los Amigos Hospital Poliomyelitis Clinical Study Center, Downey, Calif., and the Department of Internal Medicine, College of Medical Evangelists, Los Angeles, Calif.Supported by grants from the American Heart Association and the National Institutes of Health (H-3987). The Poliomyelitis Clinical Study Center is aided by a grant from the National Foundation.Requests for reprints should be addressed to Lloyd T. Iseri, M.D., Chief, Cardiovascular Research, Rancho Los Amigos Hospital, 7601 E. Imperial Highway, Downey, Calif. PreviousarticleNextarticle Advertisement FiguresReferencesRelatedDetails Metrics Cited byChanges in fibrinolytic activity in diving grey sealsPathogenesis and management of congestive heart failure—revisitedIncreases in plasma oncotic pressure during acute cardiogenic pulmonary edema.The effect of exercise on haematocrit, plasma volume and viscosity in diabetes mellitusREFERENCESMetabolic and hemodynamic responses to exercise during atrial fibrillation and sinus rhythmNasal airway response to exerciseTHE EFFECT OF SHORT-TERM EXERCISE ON PLASMA VOLUME AND BLOOD PRESSURE IN GUANETHIDINE-TREATED HYPERTENSIVESHematocrit, plasma protein, plasma volume, and viscosity in early hypertensive diseaseEffect of concentrated contrast media during angiography on plasma volume and plasma osmolalityPathogenesis of Congestive Heart Failure Correlation Between Anaerobic Metabolism and Plasma Volume Changes Following ExerciseLLOYD T. ISERI, M.D., F.A.C.P., JOHN R. EVANS, M.D., MICHAEL EVANS, B.A. 1 September 1961Volume 55, Issue 3Page: 384-394KeywordsAttentionBlood plasmaHeart failureHospital medicineLongitudinal studiesPathogenesisPoliomyelitisRenal circulationSaltsSodium Issue Published: 1 September 1961 PDF downloadLoading ...