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• W1494970897 endingPage "448" @default.
• W1494970897 startingPage "437" @default.
• W1494970897 abstract "Cardiac function in clinical heart disease is governed by ventricular (1) preload, (2) contractility, (3) afterload, (4) heart rate, and (5) dyssynergy. The major types of pathophysiologic abnormalities include inotropic disturbances, systolic mechanical pressure and volume overloads and diastolic mechanical ventricular underloading. In contractility and systolic mechanical disorders, the cardiac compensatory mechanisms of (1) Frank-Starling principle, (2) ventricular hypertrophy, and (3) sympathetic nervous system furnish substantial but limited protective reserve for maintaining cardiac output. Assessment of cardiac performance by pump (hemodynamics) and muscle (isovolumic and ejection mechanics) characteristics, including measurements of inotropic indexes of contractile force and velocity properties, provides quantitative analysis of ventricular function determinants and compensatory system interactions in heart disease. Congestive heart failure is compensated when resting cardiac output is maintained at normal levels by the adaptive reserves with their deleterious early effects: dyspnea (preload rise), angina pectoris (increased mass) and tachycardia (adrenergic activity). Decompensated congestive heart failure is the inability of the heart to deliver normal basal cardiac output with attendant late symptoms of fatigue at rest and body organ failure despite maximal use of protective reserves. The compensatory responses utilized and the critical level of depressed contractility causing decompensation are dependent on the specific pathophysiologic condition. Thus, the fundamental variable in congestive heart failure is inotropic integrity of which its abnormal degree determines decompensation in chronic heart disease. Compensation can be sustained by reserve mechanisms at a lower inotropic state in cardiomyopathy than in systolic mechanical disorders in which volume overload can be compensated for at a more depressed level of contractility than pressure overload. The standard classification of clinical function in congestive heart failure is based more on early symptoms consequent to secondary adjustments (compensatory mechanisms) than on disturbances of the primary factors of decompensation: cardiac output (crucial hemodynamic variable) and contractility (the fundamental determinant)." @default.
• W1494970897 created "2016-06-24" @default.
• W1494970897 creator A5018832071 @default.
• W1494970897 date "1973-09-01" @default.
• W1494970897 modified "2023-09-24" @default.
• W1494970897 title "Regulation of cardiac performance in clinical heart disease" @default.
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