THE PATHOLOGICAL PHYSIOLOGY OF THE EARLY MANIFESTATIONS OF LEFT VENTRICULAR FAILURE

Abstract

When the left heart fails, the left ventricle dilates. This dilatation is followed by an accumulation of blood in the left auricle and a rise in left auricular pressure. These changes, as the process continues, are followed by an increase in the blood vol. in the lungs and by a rise in pressure in the pulmonary vessels unless there is a corresponding increase in the vascular bed. Such failure may occur without associated failure of the right ventricle. Therefore, the diagnosis of heart failure does not require high systemic venous pressure, an enlarged liver, or peripheral edema; it may be made on the evidence of isolated failure of the left ventricle. Early evidences of such failure include: gallop rhythm, diminished vital capacity, prolonged pulmonary circulation time, Roentgen-ray evidence of pulmonary congestion, and sundry varieties of dyspnea. Our knowledge of left ventricular failure would profit greatly by the invention of a method of measuring the pulmonary arterial and venous pressures in patients.