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February 10, 1962

Clinical Science

JAMA. 1962;179(6):441-449. doi:10.1001/jama.1962.03050060051007

Recent Conceptual Advances in Congestive Heart Failure  Richard Gorlin, M.D., BostonVIRTUALLYate in congestive heart failure. Yet, despite its frequency and importance, little it known about heart failure except in purely descriptive terms. The purpose of this communication is to bring attention to recent fundamental advances in biochemistry and biophysics as they relate to a better understanding of the phenomenon of heart failure.Classically, it is accepted that symptoms originate from 2 physiological bases: venous congestion behind an overfilled dilated ventricle and inadequate cardiac output in relation to bodily need. The venous congestion is considered to be a functional expression of the Frank-Starling law of the heart, aided and abetted by excess conservation of salt and water by the body. The wherefor of the low cardiac output, or more correctly, the low stroke output, is more tenuous. Why is the failing heart capable of delivering normal or increased blood pressure,