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• W2335293885 abstract "Introduction: The basis for defining and treating heart failure is the work of Guyton, in particular the “Pressure Equation” ([MAP-CVP] = CO x SVR). In Guyton’s model, SVR is the downstream work against which the LV ejects, and it is therefore argued that decreasing SVR decreases cardiac work and improves cardiac performance. Guyton’s equation is true when flow is continuous (CPB) or heart rate is constant (pacing), but when HR and SV both vary, the equation results in 4 systematic errors. When the relationship between systemic pressure and cardiac performance is expressed by the relationship “MAP-CVP = SV x R”, a different relationship between heart and circulation can be defined, in which the systemic pressure gradient (MAP-CVP), SV and R (MAP-CVP/SV) are all necessary to tissue perfusion and organ function. The normal pressure field defined using this alternative equation is age and gender and BSA specific. Patients with heart failure presenting for surgery were hemo-dynamically evaluated before, during and after anesthesia. Methods: Over 52 months, 501 elderly patients (253M,248F) presenting for elective major surgery or endo vascular intervention received a radial arterial line and Flotrac/Vigileo transducer. All patients had pre-anesthetic insertion of a central venous line. Hemodynamic data was collected at 20–60 second intervals before, during and after surgery, and the data was plotted graphically to examine the cardiac (SV) and vascular components of the systemic pressure gradient. 10 patients with clinical heart failure were evaluated in relation to the Pressure Field defined by normal subjects without heart failure. Results: Gender, age and BSA are major determinants of pressure and flow regulation in the aging circulation. When 10 patients with overt clinical failure were compared with over 500 normal subjects, all heart failure patients had an abnormal low systemic pressure gradient (MAP-CVP). When the pressure field was plotted and compared with normal controls, half the patients had an abnormally low SV and SV range, but the other half had a low Resistance with a preserved SV. No patient with a diagnosis of heart failure had a normal pressure field. Conclusions: Heart failure is a symptom complex characterized by inadequate tissue perfusion. All subjects with heart failure have an abnormally low perfusion pressure, but the underlying cause may be vascular failure/microangiopathic disease rather than pump failure." @default.
• W2335293885 created "2016-06-24" @default.
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• W2335293885 date "2013-12-01" @default.
• W2335293885 modified "2023-09-25" @default.
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• W2335293885 doi "https://doi.org/10.1097/01.ccm.0000439422.36009.44" @default.
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