Is the heart a pressure or flow generator? Possible implications and suggestions for cardiovascular pedagogy

Furst, Branko; O’Leary, Anthony M.

doi:10.1152/advan.00191.2015

Cited by 6 publications

(4 citation statements)

References 8 publications

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“…This cyclic process resembles the workings of a compression pump, as described in thermodynamics. The concept of "propulsion pump" has been widely accepted, but occasionally also challenged (1,5). Regardless of preference regarding the primary mechanisms involved, it is clear that the PV loop representation provides an adequate characterization of the observable behavior of the heart.…”

Section: The Pv Loop For the Ventriclementioning

confidence: 99%

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Left ventricular volume analysis as a basic tool to describe cardiac function

Kerkhof¹,

Kuznetsova

Ali³

et al. 2018

Advances in Physiology Education

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The heart is often regarded as a compression pump. Therefore, determination of pressure and volume is essential for cardiac function analysis. Traditionally, ventricular performance was described in terms of the Starling curve, i.e., output related to input. This view is based on two variables (namely, stroke volume and end-diastolic volume), often studied in the isolated (i.e., denervated) heart, and has dominated the interpretation of cardiac mechanics over the last century. The ratio of the prevailing coordinates within that paradigm is termed ejection fraction (EF), which is the popular metric routinely used in the clinic. Here we present an insightful alternative approach while describing volume regulation by relating end-systolic volume (ESV) to end-diastolic volume. This route obviates the undesired use of metrics derived from differences or ratios, as employed in previous models. We illustrate basic principles concerning ventricular volume regulation by data obtained from intact animal experiments and collected in healthy humans. Special attention is given to sex-specific differences. The method can be applied to the dynamics of a single heart and to an ensemble of individuals. Group analysis allows for stratification regarding sex, age, medication, and additional clinically relevant covariates. A straightforward procedure derives the relationship between EF and ESV and describes myocardial oxygen consumption in terms of ESV. This representation enhances insight and reduces the impact of the metric EF, in favor of the end-systolic elastance concept advanced 4 decades ago.

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Section: The Pv Loop For the Ventriclementioning

confidence: 99%

“…To compare Emax and Ea for any given ventricle, it became common practice to calculate an arterial-ventricular coupling index k ϭ Emax ⁄ Ea (5) which can be reduced to SV/(ESV Ϫ Vo), because ESP cancels out. Interestingly, the value for k has no dimension, and potentially strongly depends on Vo.…”

Section: Applications Of the Vrgmentioning

confidence: 99%

Left ventricular volume analysis as a basic tool to describe cardiac function

Kerkhof¹,

Kuznetsova

Ali³

et al. 2018

Advances in Physiology Education

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“…Based on a systematic research of circulation models, Branko Furst, M.D., professor of anesthesiology, Albany Medical College, Albany, New York, USA, found that this old pressure-propulsion paradigm no longer stands up to the rigor of scientific evidence. [196][197][198][199][200] A comprehensive review of the literature explored in his 2014 monograph (second edition in 2020), The Heart and Circulation: An Integrative Model, 201 and later summarized in a review article, 197 demonstrate that numerous phenomena, ranging from basic cardiovascular physiology to embryology, comparative anatomy and clinical medicine, contradict the conventional pressurepropulsion model. These anomalous findings call for a reappraisal of the mechanistic, solely physicalist view of the cardiovascular system that is so deeply ingrained in the collective scientific, medical, and popular psyche.…”

Section: The Heart and Circulationmentioning

confidence: 99%

Anthroposophic Medicine: A Short Monograph and Narrative Review—Foundations, Essential Characteristics, Scientific Basis, Safety, Effectiveness and Misconceptions

Bartelme

2020

Glob Adv Health Med

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Introduction Anthroposophic medicine is a form of integrative medicine that originated in Europe but is not well known in the US. It is comprehensive and heterogenous in scope and remains provocative and controversial in many academic circles. Assessment of the nature and potential contribution of anthroposophic medicine to whole person care and global health seems appropriate. Methods Because of the heterogenous and multifaceted character of anthroposophic medicine, a narrative review format was chosen. A Health Technology Assessment of anthroposophic medicine in 2006 was reviewed and used as a starting point. A Medline search from 2006 to July 2020 was performed using various search terms and restricted to English. Books, articles, reviews and websites were assessed for clinical relevance and interest to the general reader. Abstracts of German language articles were reviewed when available. Reference lists of articles and the author’s personal references were also consulted. Results The literature on anthroposophic medicine is vast, providing new ways of thinking, a holistic view of the world, and many integrating concepts useful in medicine. In the last ∼20 years there has been a growing research base and implementation of many anthroposophical concepts in the integrated care of patients. Books and articles relevant to describing the foundations, scientific status, safety, effectiveness and criticisms of anthroposophic medicine are discussed. Discussion An objective and comprehensive analysis of anthroposophic medicine finds it provocative, stimulating and potentially fruitful as an integrative system for whole person care, including under-recognized life processes and psychospiritual aspects of human beings. It has a legitimate, new type of scientific status as well as documented safety and effectiveness in some areas of its multimodal approach. Criticisms and controversies of anthroposophic medicine are often a result of lack of familiarity with its methods and approach and/or come from historically fixed ideas of what constitutes legitimate science.

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“…Misinterpretation of this basic mechanism of heart-vasculature interaction at the level of the filling side of the heart has led to the establishment of a false dichotomy whereby either the heart or the vasculature is considered 'primary' in CO regulation Henderson, et al, 2010;Furst and O'Leary, 2016).…”

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confidence: 99%

What makes the blood go around?

Dalmau

2020

Journal of Experimental Biology

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Is the heart a pressure or flow generator? Possible implications and suggestions for cardiovascular pedagogy

Cited by 6 publications

References 8 publications

Left ventricular volume analysis as a basic tool to describe cardiac function

Left ventricular volume analysis as a basic tool to describe cardiac function

Anthroposophic Medicine: A Short Monograph and Narrative Review—Foundations, Essential Characteristics, Scientific Basis, Safety, Effectiveness and Misconceptions

What makes the blood go around?

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