CONGESTIVE heart failure has usually been considered to be a global affection of the myocardium in which disturbance of contraction in one or both ventricles is generalized. On the other hand, abnormal myocardial contraction may be caused by local areas of malfunctioning myocardium interacting with other areas of completely normal muscle. The possibility that unco-ordinated contraction of the heart results from such a combination of normal and abnormal muscle has received little attention.In 1925 Wiggers1 described the pattern of left ventricular contraction as a "series of sequential fractionate contractions of muscle bundles." He suggested that disturbance in this temporal . . .
Funding and Disclosures
Supported by grants (HE 08591 and 1 T1 5679) from the National Institutes of Health,. United States Public Health Service, the Peter Bent Brigham Hospital (General Research Support 9941 and 9950–9) and the Kriendler Memorial Foundation.
We are indebted to Dr. A. Bartholomay for the use of computer facilities of the Biomathematics Laboratory and to Drs. H. G. Kemp, J. M. Sullivan and S. Wolfson for assistance in the individual case studies.
Author Affiliations
* From the Cardiovascular Unit and the Department of Medicine. Peter Bent Brigham Hospital and Harvard Medical School (requests for reprints should be addressed to Dr. Gorlin at the Peter Bent Brigham Hospital, 721 Huntington Avenue, Boston, Massachusetts 02115).
† Staff cardiologist, United States Naval Hospital, San Diego, California; formerly, postdoctoral fellow, National Heart Institute, National Institutes of Health.
‡ Research fellow in medicine, Harvard Medical School; assistant in medicine, Peter Bent Brigham Hospital; formerly, research trainee, National Heart Institute, National Institutes of Health.
§ Base cardiologist, Eglin Air Force Base, Florida; formerly, postdoctoral fellow, National Heart Institute, National Institutes of Health.
¶ Assistant professor of medicine, Harvard Medical School; physician and director, Cardiovascular Unit, Peter Bent Brigham Hospital; investigator, Howard Hughes Medical Institute.
