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Studies in congestive heart failure. IV. The potassium content of skeletal and cardiac muscle
296
THE
AMERICAN
HEART
JOURNAL
In patients who have had edema of severe degree for a long time, the limiting factor, in so far as gas exchange is concerned, does not appear to be decreased oxygen intake but inability to acquire a large (normal) oxygen debt, and this discrepancy is believed to bc due to impairment of tissue buffering power. Pilcher,
Cobb,
Clark,
Gurney,
Heart
Failure.
III.
Invest.
8: 291,
1930.
and
The Buffering
Harrison,
Power
Tinsley
R.:
of the Blood
Studies
in
Congestive J. Clin.
and Tissues.
The Pn and carbon dioxide content of the blood of normal subjects and of patients with congestive heart failure has been studied before and after (a) administration of large doses of ammonium chloride, (b) breathing 5 per cent carbon dioxide and (c) a standardized exercise. The’ findings in patients with heart failure at rest were usually within normal limits, but a state of acidosis was found in three patients with very severe symptoms. The changes occurring after administration of ammonium chloride and after breathing carbon dioxide were usually within normal limits in patients with congestive failure. The changes in Px after exercise were usually greater in decompensated patients than in control subjects, and the degree of change was, with one exception, proportional to the extent and duration of the edema. This is believed to be compatible with the presence of diminished buffering power of the tissues in heart failure. One compensated cardiac patient showed changes similar to those found in control subjects and one patient with noncardiac e,dema showed changes. similar This suggests that edema itself may bc to those in the decompensated patients. related to changes in the tissues of patients with heart failure.
Harrison, Tin&y Heart Failure. Clin.
Invest.
R., Pilcher, Cobb, and Ewing, George: Studies in Congestive IV. The Potassium Content of Skeletal and Cardiac Muscle. J. 8:
325,
1930.
The potassium content of the skeletal and cardiac muscle of individuals dying of congestive heart failure was found to be less than that of subjects dying without The potassium content per unit of dry weight of edematous muscle was edema. less than that of nonedematous muscle. This was true whether the edema was due to heart disease or not. The suggestion is offered that loss of potassium with consequent diminution in the buffering power of the heart muscle constitutes a physicochemical factor in the fatigue” In patients with congestive cardiac failure the production of “cardiac decrease in potassium is believed to have been originally an effect of heart failure, but is considered as probably a secondary but important cause of subsequent breaks in compensation.
P&her, Cobb, Calhoun, J. Alfred, Cullen, Glenn E., and Harrison, Studias in Congestive Heart Failure. V. The Potassium Content Muscle Obtained by Biopsy. J. Clin. Invest. 9: 191, 1930.
Tins&y R.: of Skeletal
The water content of pieces of gastrocnemius muscle removed by biopsy from patients with cardiac edema was invariably increased. The percentage of solids These changes usually persisted after clinical signs was correspondingly decreased. of edema had disappeared. The potassium content of the wet muscle from edematous patients was invariably abnormally low. The amount of potassium in the dry As edema decreased, the potassium muscle was usually but not always diminished. that of the dry muscle increased content of the wet muscle rose in three subjects; in two of them.
THE
AMERICAN
HEART
JOURNAL
In patients who have had edema of severe degree for a long time, the limiting factor, in so far as gas exchange is concerned, does not appear to be decreased oxygen intake but inability to acquire a large (normal) oxygen debt, and this discrepancy is believed to bc due to impairment of tissue buffering power. Pilcher,
Cobb,
Clark,
Gurney,
Heart
Failure.
III.
Invest.
8: 291,
1930.
and
The Buffering
Harrison,
Power
Tinsley
R.:
of the Blood
Studies
in
Congestive J. Clin.
and Tissues.
The Pn and carbon dioxide content of the blood of normal subjects and of patients with congestive heart failure has been studied before and after (a) administration of large doses of ammonium chloride, (b) breathing 5 per cent carbon dioxide and (c) a standardized exercise. The’ findings in patients with heart failure at rest were usually within normal limits, but a state of acidosis was found in three patients with very severe symptoms. The changes occurring after administration of ammonium chloride and after breathing carbon dioxide were usually within normal limits in patients with congestive failure. The changes in Px after exercise were usually greater in decompensated patients than in control subjects, and the degree of change was, with one exception, proportional to the extent and duration of the edema. This is believed to be compatible with the presence of diminished buffering power of the tissues in heart failure. One compensated cardiac patient showed changes similar to those found in control subjects and one patient with noncardiac e,dema showed changes. similar This suggests that edema itself may bc to those in the decompensated patients. related to changes in the tissues of patients with heart failure.
Harrison, Tin&y Heart Failure. Clin.
Invest.
R., Pilcher, Cobb, and Ewing, George: Studies in Congestive IV. The Potassium Content of Skeletal and Cardiac Muscle. J. 8:
325,
1930.
The potassium content of the skeletal and cardiac muscle of individuals dying of congestive heart failure was found to be less than that of subjects dying without The potassium content per unit of dry weight of edematous muscle was edema. less than that of nonedematous muscle. This was true whether the edema was due to heart disease or not. The suggestion is offered that loss of potassium with consequent diminution in the buffering power of the heart muscle constitutes a physicochemical factor in the fatigue” In patients with congestive cardiac failure the production of “cardiac decrease in potassium is believed to have been originally an effect of heart failure, but is considered as probably a secondary but important cause of subsequent breaks in compensation.
P&her, Cobb, Calhoun, J. Alfred, Cullen, Glenn E., and Harrison, Studias in Congestive Heart Failure. V. The Potassium Content Muscle Obtained by Biopsy. J. Clin. Invest. 9: 191, 1930.
Tins&y R.: of Skeletal
The water content of pieces of gastrocnemius muscle removed by biopsy from patients with cardiac edema was invariably increased. The percentage of solids These changes usually persisted after clinical signs was correspondingly decreased. of edema had disappeared. The potassium content of the wet muscle from edematous patients was invariably abnormally low. The amount of potassium in the dry As edema decreased, the potassium muscle was usually but not always diminished. that of the dry muscle increased content of the wet muscle rose in three subjects; in two of them.