The Mechanism of the Increased Venous Pressure With Exercise in Congestive Heart Failure*†

was of prime importance in precipitating the clini-cal manifestations of congestive heart failure in beriberi as well as other forms of heart disease (1). Further work since that time has not modi-fied this opinion in the mind of the physician or the physiologist, but has raised questions as to the mechanism involved (2, 3). In the present experiments, patients with overt congestive heart failure and patients who had re-covered from congestive heart failure were stud-ied with regard to their peripheral venomotor and venous pressure responses to mild exercise of the legs. The effect of sympathetic ganglioplegia upon the responses to exercise was investigated. The studies were repeated with circulatory arrest of the exercising legs. These experiments indicate that the mechanism of the increase in venous pressure with exercise is an efferent sympatho-adrenal discharge with constriction of the peripheral veins. The level of exercise employed did not produce the venocon-striction in compensated patients. METHODS Patients with cardiac decompensation due to hyper-tension, aortic and mitral valvular disease, coronary ar-tery disease, and advanced pulmonary disease were stud-ied. Patients who had had congestive heart failure, but were compensated at the time of study served as control subj ects. The criteria for the presence of congestive heart failure were roentgenographic and electrocardio-graphic evidence of heart chamber enlargement com-mensurate with the cardiac handicap. Sustained diastolic hypertension, murmurs indicative of aortic or mitral