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Pathogenesis of Congestive Heart Failure: Correlation Between Anaerobic Metabolism and Plasma Volume Changes Following Exercise

LLOYD T. ISERI, M.D., F.A.C.P.; JOHN R. EVANS, M.D.; and MICHAEL EVANS, B.A.
Ann Intern Med. 1963;59(6):788-797. doi:10.7326/0003-4819-59-6-788
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It has been stated frequently that congestive heart failure occurs when cardiac output is not sufficient enough to meet the "metabolic needs" of the body. What these "metabolic needs" are and how inability to meet these needs causes fluid and sodium retention in cardiac patients have not been elucidated.

Huckabee and Judson (1) recently showed that symptomatic cardiac patients subjected to mild exercise demonstrated an increase in the rate of anaerobic metabolism. Asymptomatic patients revealed no such increase. Donald and associates (2) found that increased lactic acid production (that is, increased anaerobic metabolism) by cardiac patients during exercise was related

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