forgotten cardiovascular physiology by myburgh
TRANSCRIPT
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Forgotten physiology
John A Myburgh
Sydney
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Dario Maestrini1886-1975
Legge dei cuore: 1914
The mechanical energy set free in the passage from the resting to the active state is a function of the length of the fibre.
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Ernest Starling1866-1927
Otto Frank1865-1944
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Georg Ohm1789-1854
Die galvanische Kette, mathematisch bearbeitet: 1927
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Q
P
W Q
Georg Ohm1789-1854
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WR Q
V
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Rivers: NEJM 2001
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Zhang: Trials 2013
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Arthur Guyton 1919-2003
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Mean arterial pressure
Cardiac output Right atrialpressure
Mean systemic pressure
Perfusion pressure
Unstressedvolume
Stressedvolume
Venous return
Arteriolar tone
15mmHg15mmHg
5mmHg
60mmHg
60mmHg
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Right atrial pressure (mmHg)0
10
Venous return
l/min
Cardiac function
Mean systemic pressure
Guyton
CO = VR = (Pms – RAP) / RVRStarling
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MAP Volume
Stroke volume
ImpedanceCardiac
RAP ANS
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P= Vs / C
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The physiological fallacyBased on a common phenotype and surrogate variables
Assumes an inference, that cannot be measured, that the patient has inadequate organ blood flow.
Assumes a second inference, that also cannot be measured, that a single intervention will restore the complexity of altered haemodynamics in a predictable and safe fashion for the duration of the illness.
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Drug: A term of varied usage. In medicine, it refers to any substance with the potential to prevent or cure disease or enhance physical or mental welfare. (www.WHO.int)
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John Maynard Keynes1883-1946
The difficulty lies, not in new ideas, but in escaping old ones, which ramify, for those brought up with them, as most of us have been, into every corner of our minds.