Energy Metabolism of the Failing Heart

Abstract

Starling (1915) showed that the normal heart dilates only when increased work is thrown upon it. In disease the heart dilates without any increase in work imposed upon it. It is obviously of importance to know in what particulars the failing heart differs from the normal. The experiments recorded here amplify the results of Starling and Visscher (1927) in elucidating this problem. In their experiments it was found that the energy liberation in the normal heart is fixed by the size of the heart at the beginning of contraction; i.e., at the end of diastole. The size of the heart is a measure of the length of the muscle fibers; consequently their results may be expressed by saying that the quantity of energy liberated in contraction is determined by the length of the fiber at the time of contraction.As a matter of fact, we are more fundamentally interested in the amount of work the heart can do than we are in the total energy it can liberate. Therefore the proportion of the total energy which can be put to useful work, which is the efficiency, becomes a matter of first importance. In cardiac decompensation in man, as well as under certain conditions in experiments on hearts of lower animals, the heart dilates progressively in spite of a uniform or even decreasing load. One ordinarily speaks of such a heart as having poor tone. The heart of a decompensated patient does little work in spite of its enormous size and its apparent effort. The question as to whether the heart under these circumstances is defective in liberating less energy than a normal heart would, or is defective in being unable to use the energy for work in ejecting blood, was investigated by Starling and Visscher (1927). They found that when the mammalian heart lost its normal tonus, and dilated enormously in order to do amounts of work that when fresh it could do at small volume, the total energy

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