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THE cardinal underlying features of congestive heart failure – namely, chamber enlargement (large systolic residue), low cardiac output and venous congestion – are well documented. Nonetheless, precise definition of heart failure is difficult. This is probably because the fundamental defect (or defects) within the myocardium that initiates the complex train of events leading to overt congestive heart failure remains unknown. Since the prime function of the heart is maintenance of appropriate cardiac output, it appears reasonable to define heart failure as existing when cardiac output is limited by inadequacy of cardiac performance in relation to systemic metabolic demands, rather than . . .
Shaffer et al. (Thu,) studied this question.