Congestive Heart FailureVolume 13, Issue 5 p. 296-296 Free Access Historical Vignettes in Heart Failure First published: 09 October 2008 https://doi.org/10.1111/j.1527-5299.2007.06252.xAboutSectionsPDF ToolsRequest permissionExport citationAdd to favoritesTrack citation ShareShare Give accessShare full text accessShare full-text accessPlease review our Terms and Conditions of Use and check box below to share full-text version of article.I have read and accept the Wiley Online Library Terms and Conditions of UseShareable LinkUse the link below to share a full-text version of this article with your friends and colleagues. Learn more.Copy URL Share a linkShare onFacebookTwitterLinkedInRedditWechat History of Heart Failure “The longer the muscle (within physiological limits) the greater the amount of chemical energy, heat production and tension set up when the muscle passes from the resting to the active condition . . . . the law of the heart . . . . is the same as that for skeletal muscle, namely that the mechanical energy set free on passage from the resting to the contracted state depends on the area of chemically active surface, i.e. on the length of the muscle fibers . . . . If for any reason the heart fails in its pumping action, the blood will remain in the auricles and ventricles and will prevent the further entry of blood from the reservoir. The heart will dilate more and more after each inefficient systole, while the pressure in the great veins will rise steadily; but this rise of pressure will be associated not with increased output from the ventricles but with diminished output. We have therefore to distinguish between a rise in venous pressure which is effective in dilating the heart during diastole and increasing its output and a rise of venous pressure which is passively induced by failure of the pumping action of the heart.”1,2 Commentary English physiologist Ernest Henry Starling (1866–1927) made many important contributions to medical science, but he is remembered mainly for his “law of the heart,” published in 1914. Starling designed an experimental model of heart failure that used a canine heart preparation and had a series of manometers to measure the various pressures of the system. By varying the venous pressure and measuring the cardiac output, Starling created the well-known curve that explained heart function. He wrote, “The longer the muscle (within physiological limits) the greater the amount of chemical energy, heat production and tension set up when the muscle passes from the resting to the active condition . . . . the law of the heart…is the same as that for skeletal muscle, namely that the mechanical energy set free on passage from the resting to the contracted state depends on the area of chemically active surface, i.e. on the length of the muscle fibers . . . . ” Using his experimental model, Starling also linked the syndrome of heart failure to a decrease in the heart's pumping ability that causes more blood to remain in the cardiac chambers at the end of systole and prevents adequate venous return. He further observed that this volume overload in the cardiac chambers produces an increase in venous pressure. However, this increase in venous pressure is incapable of increasing preload and cardiac output. He wrote, “We have therefore to distinguish between a rise in venous pressure which is effective in dilating the heart during diastole and increasing its output and a rise of venous pressure which is passively induced by failure of the pumping action of the heart . . . . ” References 1 Patterson SW, Starling EH. On the mechanical factors which determine the output of the ventricles. J Physiol. 1914; 48: 357. 2 Patterson SW, Piper H, Starling EH. The regulation of the heart beat. J Physiol. 1914; 48: 465. Volume13, Issue5September/October 2007Pages 296-296 ReferencesRelatedInformation