The lymphatic circulation was evaluated after cannulation of the cervical thoracic duct in 12 patients with severe intractable congestive heart failure. After venting the distended duct, lymph flowed rapidly under increased pressure, and signs and symptoms of circulatory congestion were dramatically relieved. Dyspnea, orthopnea, anorexia, abdominal discomfort, distended neck veins, hepatomegaly, peripheral and scrotal edema, and ascites diminished or disappeared. Central venous pressure fell and armto-tongue circulation time decreased. In some patients arterial pressure, amplitude of peripheral pulses, central venous Po2, and urinary output rose further suggesting enhanced cardiac output. Considered together with previous observations in experimental animals, the findings indicate that elevated systemic venous pressure greatly increases formation of thoracic duct lymph but at the same time impedes the return of lymph into the great veins. While therapeutic drainage of lymph from the thoracic duct in patients with cardiac failure is limited, the capacity of the lymphatic system to transport excess capillary filtrate back to the blood stream constitutes a major control mechanism regulating the manifestations of this disorder. Additional Indexing Words:Central venous pressure Circulation tin C ONTROVERSY concerning the pathogenesis of edema in congestive heart failure has centered around the manner in From the
In 8 patients with complete heart block, cardiac and hemuodynammic functions were determined by methods based on cardiac catheterization. The data characterize the impairment in these functions in asymptomatic subjects and indicate, in addition, the further changes over the course of several years in the same subject, the deleterious effects associated with congestive heart failure, and the changes toward normal induced by isopropylnorepinephrine, a symaipathomiimetic amine known to stimulate the heart and increase ventricular rate in heart block.THE purpose of this report is to present data regarding cardiovascular hemodynamicg functions in patients with established complete heart block.Levinson et al.1 determined cardiovascular dynamics by cardiac catheterization in 5 patients with complete heart block, without congestive heart failure at any time, and reported the following lienodynamnic alterations from the normal: elevated systolic pressure in the right atrium, elevated systolic pressure in the right ventricle and pulmonary artery, increased pulse pressure in pulmonary and systemic arteries, increased stroke volume, and decreased cardiac output. The present study confirms these observations and reports additional information on the following cardiovaseular aspects of complete heart block: changes in cardiovascular dynamics in the same patient over the course of several years, comparison of hemodynamic functions when there is congestive heart failure with the hemodynamic status when heart failure is absent, the hemodynamic effects of isopropylnorepinephrine, a sympathomimetic amine known to increase the ventricular rate in complete heart block.2 Renal hemodynamic functions of 3 of the subjects are also reported.
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