A consideration of the mechanism of congestive heart failure

Abstract

The numerous aspects of the mechanism of congestive heart failure herein presented attest to the extremely complex nature of the clinical syndrome. Many phenomena are concerned with production of the various manifestations of the syndrome. It appears certain that although an increase in venous pressure contributes to the formation of edema, it is not the only factor responsible, nor does the venous hypertension result solely from a “dam in the stream.” Chronic congestive heart failure cannot be explained simply on the basis of the mechanisms previously defined by the backward or forward concepts. There are many important, interesting, and incompletely understood hemodynamic phenomena associated with heart failure. The role of the kidneys, of the endocrine system, and of cellular or enzymatic phenomena are presently being investigated. These factors are probably important contributors to the syndrome of congestive heart failure; their precise role is unknown. The foregoing discussion does not constitute a review of the literature but rather a brief, and surely incomplete, presentation of the problem. Certain hemodynamic principles have been emphasized which seem to escape the consideration of most clinicians and, at times, even of those especially interested in the syndrome.