Adequate information as to the state of the peripheral circulation in health and in various stages of heart disease is lacking. Some investigators1 still consider that the behavior of the peripheral circulation is entirely dependent on the action of the heart, and that disturbances of this circulation can be regarded as an index of an early stage of heart failure. Eppinger and his co-workers,2 on the other hand, have claimed that primary changes in the peripheral circulation precipitate failure of the diseased heart. Still other workers have presented evidence indicating that the early clinical manifestations of failure depend, as a rule, on changes in the pulmonary circulation due to cardiac insufficiency. In certain types of heart disease with primary failure of the left ventricle, such as arterial hypertension, arteriosclerosis and aortic insufficiency, a severe degree of disability may be present, with marked alteration in the hemodynamics of the
WEISS S, ELLIS LB. OXYGEN UTILIZATION AND LACTIC ACID PRODUCTION IN THE EXTREMITIES DURING REST AND EXERCISEIN SUBJECTS WITH NORMAL AND IN THOSE WITH DISEASED CARDIOVASCULAR SYSTEMS. Arch Intern Med (Chic). 1935;55(4):665–680. doi:10.1001/archinte.1935.00160220135009
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