Studies in Congestive Heart Failure

As a result of their studies of the respiratory exchange of decompensated cardiac patients during and after exercise, Eppinger, Kisch and Schwarz (1927) concluded that the buffering power of the tissues was diminished. Laszlo (1928) found diminished phosphate content of the cardiac and skeletal muscle of such individuals. Harrison and Pilcher determined oxygen utilization during various degrees of edema (1930a) and oxygen debt in patients with congestive heart failure (1930b). In both studies the findings were believed to be indicative of diminished alkaline reserve in the muscles. Observations by Pilcher, Clarke and Harrison (1930) of the hydrogen ion concentration of the blood of patients with congestive heart failure after exercise lead to the same conclusion. In order to obtain more direct data on this point it was thought advisable to investigate the chemical changes in the tissues themselves. As potassium is the most abundant basic element in muscle tissue it seemed wise to study it first. Harrison, Pilcher and Ewing (1930) analyzed samples of cardiac and skeletal muscle obtained from patients who had died of congestive heart failure and found them to be abnormally poor in potassium. It seemed conceivable that such a phenomenon might be related to changes after death and consequently, before proceeding further with our studies on postmortem tissues, it was deemed wise to analyze tissues obtained during life. Such a procedure had the additional advantage of allowing us to make more than one observation on the same patient and hence to follow changes in potassium content under various conditions.