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Die antagonistische Funktion des Herzmuskels unterstützt die Autoregulation nach Frank-Starling: Teil I: Struktur und Funktion des Herzmuskels [The antagonistic function of the heart muscle sustains the autoregulation according to Frank and Starling: Part I: Structure and function of heart muscle.]

Lookup NU author(s): Professor Bob Anderson

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Abstract

© 2018, Springer Medizin Verlag GmbH, ein Teil von Springer Nature.In the tradition of Harvey and according to Otto Frank the heart muscle structure is arranged in a strictly tangential fashion hence all contractile forces act in the direction of ventricular ejection. In contrast, morphology confirms that the heart consists of a 3-dimensional network of muscle fibers with up to two fifths of the chains of aggregated myocytes deviating from a tangential alignment at variable angles. Accordingly, the myocardial systolic forces contain, in addition to a constrictive also a (albeit smaller) radially acting component. Using needle force probes we have correspondingly measured an unloading type of force in a tangential direction and an auxotonic type in dilatative transversal direction of the ventricular walls to show that the myocardial body contracts actively in a 3-dimensional pattern. This antagonism supports the autoregulation of heart muscle function according to Frank and Starling, preserving ventricular shape, enhances late systolic fast dilation and attenuates systolic constriction of the ventricle wall. Auxotonic dilating forces are particularly sensitive to inotropic medication. Low dose beta-blocker is able to attenuate the antagonistic activity. All myocardial components act against four components of afterload, the hemodynamic, the myostructural, the stromatogenic and the hydraulic component. This complex interplay critically complicates clinical diagnostics. Clinical implications are far-reaching (see Part II, https://doi.org/10.1007/s00059-018-4735-x).

Publication metadata

Author(s): Lunkenheimer PP, Niederer P, Lunkenheimer JM, Keller H, Redmann K, Smerup M, Anderson RH

Publication type: Article

Publication status: Published

Journal: Herz

Year: 2018

Pages: epub ahead of print

Online publication date: 27/07/2018

Acceptance date: 05/07/2018

ISSN (print): 0340-9937

ISSN (electronic): 1615-6692

Publisher: Urban und Vogel GmbH

URL: https://doi.org/10.1007/s00059-018-4734-y

DOI: 10.1007/s00059-018-4734-y

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