CARDIAC OUTPUT, BLOOD AND INTERSTITIAL FLUID VOLUMES, TOTAL CIRCULATING SERUM PROTEIN, AND KIDNEY FUNCTION DURING CARDIAC FAILURE AND AFTER IMPROVEMENT.

The relation of cardiac output, blood and interstitial fluid volumes, plasma protein concentration, and kidney function in heart failure is still a subject of investigation. The majority of investigators in this country (1, 2) and in England (3, 4) have believed that the fundamental factor in heart failure is a diminished cardiac output for a given diastolic size against a given resistance, and that increase in venous pressure and blood volume are secondary phenomena, although themselves responsible for many of the symptoms of heart failure. Diminished cardiac output would first be manifested by failure to meet the oxygen requirements of the body during exercise, and only in extreme cases by a subnormal cardiac output at rest. Thus, measurements of cardiac output at rest would only be below normal in patients who showed symptoms of heart failure at rest. Since, however, even in this group Harrison (5). found the average values for cardiac output, as well as the range, similar to those in the compensated group, he concluded that diminished cardiac output was not an important factor in cardiac failure and developed his "Backward Failure" theory, attributing the major phenomenon of cardiac failure to increased venous pressure proximal to the failing (but still normally working) chamber. The oliguria and nitrogen retention of cardiac failure are attributed to passive congestion by Harrison (6) and to "extrarenal" deviation of water by Fishberg (7). Neither of these explanations is satisfactory. Increase in renal venous pressure only results in oliguria when renal blood flow is reduced. If blood flow is unchanged, increase in renal venous pressure results in diuresis (8). If the oliguria is due to diminished water available

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