The Cardiohemodynamic Effects of Venous Congestion of the Legs or of Phlebotomy in Patients With and Without Congestive Heart Failure 1

Norepinephrine Induced Pulmonary Congestion in Patients With Aortic Valve Regurgitation*

“…Interference with the venous return modifies this situation sufficiently to enable a contractility response indistinguishable from that occurring in the normal, presumably by avoiding excessive distention of the ventricle. This further verifies the similarity of this state of norepinephrine induced pulmonary congestion to low output heart failure where an enhanced performance of the myocardium also follows venous occlusion (30). Whether interference with outflow resistance alone would similarly affect the cardiac response is problematic.…”

The Effects of Venous Congestion of the Limbs and Phlebotomy Upon Renal Clearances and the Excretion of Water and Salt. Ii. Studies in Patients With Congestive Failure 1

“…Cardiohemodynamic studies in such subjects indicate that congesting the limbs usually decreases the cardiac output without consistently causing measurable changes in systemic or pulnonary arterial pressure or right ventricular enddiastolic pressure (2). Any decrease in cardiac output during venous congestion therefore appeared usually to indicate a reduction in effectively circulating blood volume, which if it were not counteracted by vasomotor (and other homeostatic) adjustments would result in definite arterial hypotension, and indeed does so when the vasomotor reflexes are blocked by drugs (8).…”

“…Right ventricular and pulmonary arterial pressures were measured simultaneously and have been presented separately (2). Suffice it to say here, these pressures decreased or remained the same, and in any case did not show any consistent correlation with changes in cardiac output or renal excretion.…”

“…Every twenty minutes arterial blood samples were obtained for the determinations of inulin, para-aminohippuric acid, chloride, sodium, potassium, and hematocrit. During the control period, one or two cardiac output determinations were made by the direct Fick method as well as measurements of the central vascular and peripheral arterial pressures as previously described (2). In 15 patients, after the control measurements had been obtained, cuffs on the thighs were inflated at slightly less than diastolic pressure (usually 70 mm.…”

“…In addition, cardiohemodynamic measurements were made simultaneously in a majority of patients in order to determine whether changes of cardiac output, or blood pressure in the pulmonary artery, or right ventricle are consistently related to the renal excretory responses. The details of the cardiohemodynamic studies have been presented in a separate communication (2).…”