The Heart in Heart Failure

SUMMARY

The inevitable occurrence of congestive heart failure in the course of chronic cardiac disease has led to much speculation concerning a possible defect in intrinsic contractile performance of the myocardium as a basis for this state. Recent evidence suggests that such a deficiency in contractile function of the myocardium is present in cardiac hypertrophy and failure. Investigative attention has been focused upon attempts to elucidate the cellular mechanismsresponsible for the alterations in myocardial performance. Present evidence indicates that the defect primarily involves the energy utilization phase of myocardial metabolism. No specific cellular locus for such a defect has been uncovered to date. It is postulated that with the development of cardiac hypertrophy ineffective coordination of the functions of the growing cellular components may account for the deficient biologic activity in the myocardium.