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Fig. 24.4 Starling curve of relationship between cardiac filling pressure and cardiac output. In phase A, reduction in blood volume (by diuretics) reduces filling pressure and cardiac output. In phase B, reduction in blood volume reduces filling pressure and increases cardiac output

10 Troughton RW et al 2000 Lancet 355:1126-1130.

11 Ernest Henry Starling 1866-1927. Professor of physiology University College, London. He also coined the word 'hormone'.

Fig. 24.4 Starling curve of relationship between cardiac filling pressure and cardiac output. In phase A, reduction in blood volume (by diuretics) reduces filling pressure and cardiac output. In phase B, reduction in blood volume reduces filling pressure and increases cardiac output

Filling pressure

Filling pressure the bedside according to how much the patient is able to do without becoming dyspnoeic, and this New York Heart Association (NYHA) classification offers also an approximate prognosis, with that of the worst grade (Class 4) being as bad as most cancers.12 Most patients with cardiac failure die from an arrhythmia, rather than from terminal decompensation, and prognosis is improved most by drugs which do not increase further the heart's exposure to elevated catecholamine concentrations (some vasodilators, but see below).

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