Cardiac Performance

High Blood Pressure Exercise Program

Hypertension Causes and Treatment

Get Instant Access

The histological effects of acute and chronic obstruction of the cardiac lymphatic system or of an imbalance of cardiac lymph formation and drainage should impair cardiac performance as mentioned above. Indeed, this has been confirmed repeatedly in the last years.

One of the earlier investigations on the functional importance of intact cardiac lymphatic drainage studied the cardiac output following cardiac lymphatic obstruction in isolated rat hearts.88 Cardiac output decreased by 33% within 90 min in the lymphostatic hearts, whereas it remained stable in hearts with freely draining lymph. The reduction in cardiac function following lymphatic obstruction was not related to coronary perfusion, which was not different in lymph obstructed and control hearts and did not change during the experiment.

In anaesthetized dogs, interruption of the cardiac lymph drainage by ligation of the epi-cardial lymphatics, the afferent and efferent lymphatics of the pretracheal and cardiac lymph nodes and of the thoracic duct caused myocardial edema within 3 hours.86 Simultaneously, the left ventricular function assessed by the preload recruitable stroke work (PRSW) was impaired significantly.86

In another study in dogs,34 cardiac lymph production was promoted by elevation of the coronary sinus pressure and cardiac lymph drainage was almost abolished by elevating the superior vena caval pressure. This maneuver produced 35% increase in myocardial extravascu-lar fluid within 3 hours and a 40% reduction in cardiac output. The impaired myocardial performance was not related to decreased coronary artery blood flow, which was maintained during increased coronary sinus pressure. Thus, the impaired myocardial function probably resulted from the myocardial edema in consequence to an imbalance of lymph formation and drainage.

Enhanced myocardial water content and depressed left ventricular performance was also observed in dogs with chronic elevation of right heart pressure by pulmonary artery banding.34 In this model, the enhanced right heart pressure affected both left ventricular microvascular filtration and cardiac lymph drainage: coronary sinus and left ventricular microvascular pressure was increased, which promoted cardiac lymph formation, and superior vena caval pressure was elevated, which impeded cardiac lymph drainage. Again, an imbalance of lymph formation and flow was present causing edema and impaired left ventricular function.

Experiments with cardiopulmonary bypass and cardiac arrest57,58 showed a reduction of cardiac lymph flow to < 30% of baseline during cardiac arrest and myocardial edema developed. Cardiac performance (assessed by PRSW) was significantly impaired after bypass and the depression was closely related to the myocardial water content.

Another experimental study101 has investigated the effect of increasing coronary sinus pressure and cardiac microvascular permeability on left ventricular dp/dtmax. These interventions caused myocardial edema and a change in dp/dtmax with time, which was closely related to the amount of edema, which had accumulated during the 3 hour experimental period. Cardiac lymphatic drainage was not experimentally impeded in these experiments. Nevertheless, the experimental interventions caused an imbalance of lymph formation and flow as shown by the development of myocardial edema.

As described above, intermittent coronary sinus occlusion (ICSO) was reported to give rise to fluid reabsorption from the myocardium at least during deflation of the coronary sinus balloon.26 Possibly, reduction of myocardial edema contributes to the functional improvement of ischemic myocardium by ICSO.102 The effect of ICSO on myocardial interstitial fluid volume, however, remains to be established.

In summary, the studies demonstrate the importance of an adequate drainage of cardiac lymph and normal myocardial water content for the performance of the heart. Acute and chronic cardiac edema impairs cardiac function. Edema develops as a consequence of an imbalance of the formation and drainage of lymph. This occurs when a high venous pressure promotes microvascular filtration and impedes lymph flow, e.g., in congestive heart failure, in pulmonary hypertension, and after a Fontan operation. The cardiac edema and the resulting histological changes including fibrosis possibly contribute to the cardiac dysfunction.

References

1. Rusznyak I, Foldi M, Szabo G. Lymphologie. Physiologie und Pathologie der Lymphgefasse und des Lymphkreislaufs. G. Fischer, Stuttgart. 1969.

2. Blair DM. The lymphatics of the heart: A Hunterian memorandum. Glasgow Med J 1925; 103:364-367.

3. Miller AJ. Lymphatics of the heart. New York: Raven Press, 1982.

4. Aagaard OC. Les vaisseaux lymphatique du coeur chez l'homme et chez quelques mammiferes: Levin and Munksgaard, Copenhagen 1924.

5. Patek PR. The morphology of the lymphatics of the mammalian heart. Am J Anat 1939; 64:203-249.

6. Drinker CK, Warren MF, Maurer FW, McCarrell JD. The flow, pressure, and composition of cardiac lymph. Am J Physiol 1940; 130:43-55.

7. Shimada T, Morita T, Oya M, Kitamura H. Morphological studies of the cardiac lymphatic system. Arch Histol Cytol 1990; 53 (suppl):115-126.

8. Leak LV. The structure of lymphatic capillaries in Lymph formation. Fed Proc 1976; 35:1863-1871.

9. Servelle M, Andrieux J, Cornu C, deLoche A, Nussaume O. Les lymphatiques du coeur (injections perioperatoires). Arch Mal Coeur 1967; 60:89-106.

10. Marchetti C, Poggi P, Calligaro A, Casasco A. Lymph vessels of the rabbit heart: Distribution and fine structure in atria. Lymphology 1986; 19:33-37.

11. Eliskova M, Eliska O. Light microscopy of the lymphatics of the human atrial wall and lymphatic drainage of the supraventricular pacemaker. Int Angiol 1989; 8:1-6.

12. Eliska O, Eliskova M. Lymphatic drainage of the ventricular conduction system in man and in dog. Acta Anat Basel 1980; 107:205-213.

13. Eliska O, Eliskova M. Contribution to the solution of the question of lympho-venous anastomoses in heart of dog. Lymphology 1975; 8:11-15.

14. Gavrish AS. Morphological changes in the heart accompanying the lymph flow disturbance. Cor Vasa 1981; 23:366-374.

15. Eliskova M, Oldrich E. How lymph is drained away from the human papillary muscle: Anatomical conditions. Cardiology 1992; 81 371-377.

16. Hukkanen M, Konttinen YT, Terenghi G, Polak JM. Peptide-containing innervation of rat femoral lymphatic vessels. Microvasc Res 1992; 43:7-19.

17. McHale NG. Lymphatic innervation. Blood Vessels 1990; 27:127-136.

18. Aukland K, Reed RK. Interstitial-lymphatic mechanisms in the control of extracellular fluid volume. Physiol Rev 1993; 73:1-78.

19. Renkin EM. Cellular and intercellular transport pathways in exchange vessels. Am Rev Respir Dis 1992; 73:1-78.

20. Levick JR. Fluid exchange across endothelium. Int J Microcirc 1997; 17:241-247.

21. Perry MA, Navia CA, Granger DN, Parker JC, Taylor AE. Calculation of equivalent pore radii in dog hindpaw capillaries using endogenous lymph and plasma proteins. Microvasc Res 1983; 26:250-253.

22. Mortillaro NA, Taylor AE. Microvascular permeability to endogenous plasma proteins in the jejunum. Am J Physiol 1990; 258:H1650-H1654.

23. Pilati CF. Macromolecular transport in canine coronary microvasculature. Am J Physiol 1990; 258:H748-H753.

24. Smith L, Andreasson S, Berglund S, Rippe B, Risberg B. Oleic acid reduces pulmonary mi-crovascular sieving capacity in sheep. J Appl Physiol 1989; 66:2866-2872.

25. Granger DN, Miller T, Allen R, Parker RE, Parker JC, Taylor AE. Permselectivity of the liver blood-lymph barrier to endogenous macromolecules. Gastroenterology 1979; 77:103-109.

26. Kenner T, Moser M, Mohl W. Arteriovenous difference of the blood density in the coronary circulation. J Biomech Eng 1985; 107:34-40.

27. Mahy IR, Tooke JE, Shore AC. Capillary pressure during and after incremental venous pressure elevation in man. J Physiol Lond 1995; 485:213-219.

28. Chilian WM, Eastham CL, Layne SM, Marcus ML. Small vessel phenomena in the coronary microcirculation: Phasic intramyocardial perfusion and coronary micro- vascular dynamics. Prog Cardiovasc Dis 1988; 31:17-38.

29. Nellis SH, Liedtke AJ, Whitesell L. Small coronary vessel pressure and diameter in an intact beating rabbit heart using fixed-position and free-motion techniques. Circ Res 1981; 48:342353.

30. Ekelund U, Björnberg J, Grande PO, Albert U, Mellander S. Myogenic vascular regulation in skeletal muscle in vivo is not dependent of endothelium-derived nitric oxide. Acta Physiol Scand 1992; 144:199-207.

31. Shore AC, Sandeman DD, Tooke JE. Effect of an increase in systemic blood pressure on nailfold capillary pressure in humans. Am J Physiol 1993; 265:H820-H8239.

32. Diana JN, Shadur C. Effect of arterial and venous pressure on capillary pressure and vascular volume. Am J Physiol 1973; 225:637-650.

33. Laine GA, Granger HJ. Microvascular, interstitial, and lymphatic interactions in normal heart. Am J Physiol 1985; 249:H834-H842.

34. Laine GA, Allen SJ. Left ventricular myocardial edema. Lymph flow, interstitial fibrosis, and cardiac function. Circ Res 1991; 68:1713-1721.

35. Mehlhorn U, Davis KL, Laine GA, Allen SJ, Geissler HJ, Adams DL. Myocardial fluid balance in acute hypertension. Microcirculation 1996; 3:371-378.

36. Rosenkranz ER, Utley JR, Menninger JF, Dembitsky WP, Hargens AR, Peters RM. Interstitial fluid pressure changes during cardiopulmonary bypass. Ann Thorac Surg 1980; 30:536-542.

37. Stewart RH, Rohn DA, Mehlhorn U, Davis KL, Allen SJ, Laine GA. Regulation of mi-crovascular filtration in the myocardium by interstitial fluid pressure. Am J Physiol 1996; 271:R1465-R1469.

38. Rabbany SY, Kresh YJ, Noordergraaf A. Differentiation of intramyocardial fluid pressure from fiber stress. Technol Health Care 1997; 5:145-157.

39. Landis EM, Pappenheimer JR. Exchange of substances through the capillary walls. In: Handbook of Physiology, Vol II, Sect 2, Circulation, 1963; 961-1034.

40. Nitta S, Ohnuki T, Ohkuda K, Nakada T, Staub NC. The corrected protein equation to estimate plasma colloid osmotic pressure and its development on a nomogram. Tohoku J Exp Med 1981; 135:43-49.

41. Vargas F, Johnson JA. An estimate of reflection coefficients of rabbit heart capillaries. J Gen Physiol 1964; 47:667-877.

42. Sexton WL, Poole DC, Mathieu-Costello O. Microcirculatory structure-function relationships in skeletal muscle of diabetic rats. Am J Physiol 1994; 266:H1502-H1511.

43. Parker JC, Perry MA, Taylor AE. Permeability of the microvascular barrier. In: Edema. Edts.: Staub NC, Taylor AE. Raven Press, New York 1984; 143-187.

44. Rippe B, Haraldsson B. Transport of macromolecules across microvascular walls: The two-pore theory. Physiol Rev 1994; 74:163-219.

45. Hauck G. Zur Frage der Existenz eines "Gradient of Vascular Permeability" an der Endstrombahn. Arch Kreislaufforsch 1969; 59:197-227.

46. Qiao RL, Bhattacharya J. Segmentel barriere properties of the pulmonary microvascular bed. J Appl Physiol 1991; 71:2152-2129.

47. Yuan Y, Chilian WM, Granger HJ, Zawieja DC. Permeability to albumin in isolated coronary venules. Am J Physiol 1993; 265:H543-H552.

48. Caldwell JH, Martin GV, Raymond GM, Bassingthwaighte JB. Regional myocardial blood flow and capillary permeability surface area products are nearly proportional. Am J Physiol

1994; 267:H654-H666.

49. Cousineau DF, Goresky CA, Rose CP, Simard A, Schwab AJ. Effects of flow, perfusion pressure, and oxygen consumption on capillary exchange. J Appl Physiol 1995; 78:1350-1359.

50. Harris TR, Gervin CA, Burks D, Custer P. Effects of coronary flow reduction on capillary-myocardial exchange in dogs. Am J Physiol 1978; 234:H679-H689.

51. Horwitz LD, Kaufmann D, Kong Y. An antibody to leukocyte integrins attenuates coronary vascular injury due to ischemia and reperfusion in dogs. Am J Physiol 1997; 272:H618-H624.

52. Tillmanns H, Neumann FJ, Tiefenbacher C, Dorigo O, Parekh N, Waas W, Zimmermann R, Steinhausen M, Kuebler W. Activation of neutrophils in the microvasculature of the ischaemic and reperfused myocardium. Eur Heart J 1993; 14 Suppl I:82-86.

53. Renkin EM, Joyner WL, Sloop CH, Watson PD. Influence of pressure on plasma-lymph transport in the dog paw: Convective and dissapative mechanisms. Microvasc Res 1977; 14:191-204.

54. Watson PD, Wolf MB. Transport parameter estimation from lymph measurements and the Patlak equation. Am J Physiol 1992; 262:H293-H298.

55. Schmid-Schönbein GW. Microlymphatics and lymph flow. Physiol Rev 1990; 70:987-1028.

56. Boucher Y, Roberge S, Roy PE. Ultrastructural comparative study on lymphatic capillaries of the subendocardium, myocardium, and subepicardium of the heart left ventricle. Microvasc Res 1985; 29:305-319.

57. Mehlhorn U, Davis KL, Burke EJ, Adams D, Laine GA, Allen SJ. Impact of cardiopulmonary bypass and cardioplegic arrest on myocardial lymphatic function. Am J Physiol 1995;

268:H178-H183.

58. Mehlhorn U, Allen SJ, Adams DL, Davis KL, Gogola GR, de-Vivie ER, Laine GA. Normo-thermic continuous antegrade blood cardioplegia does not prevent myocardial edema and cardiac dysfunction. Circulation 1995; 92:1940-1946.

59. Mislin H. Die Motorik der Lymphgefässe und die Regulation der Lymphherzen. In: Handbuch der allgemeinen Pathologie. Springer, Berlin-Heidelberg-NewYork 1972; Vol III/6:219-238.

60. Olszewski WL, Engeset A. Intrinsic contractility of prenodal lymph vessels and lymph flow in human leg. Am J Physiol 1980; 239:H775-H783.

61. Reddy NP, Staub NC. Intrinsic propulsive activity of thoracic duct perfused in anaesthetized dogs. Microvasc Res 1981; 21:183-192.

62. Hargens AR, Zweifach BW. Contractile stimuli in collecting lymph vessels. Am J Physiol

1977; 233:H57-H65.

63. Benoit JN, Zawieja DC, Goodman AH, Granger HJ. Characterization of intact mesenteric lymphatic pump and its responsiveness to edemagenic stress. Am J Physiol 1989; 257:H2059-H2069.

64. McHale NG, Roddie IC. The effect of transmural pressure on pumping activity in isolated bovine lymphatic vessels. J Physiol Lond 1976; 261:255-269.

65. Ohhashi T, Azuma T, Sakaguchi M. Active and passive mechanical characteristics of bovine mesenteric lymphatics. Am J Physiol 1980; 239:H88-H95.

66. Ohhashi T, Yokoyama S. Nitric oxide and the lymph system. Jap J Physiol 1994; 44:327-342.

67. Greiner ST, Davis KL, Zawieja DC. Effects of reactive oxygen metabolites on lymphatic pumping function. In Interstitium, connective tissue and lymphatics. Reed RK, McHale NG, Bert JL, Winlove CP, Laine GA (eds.). Portland Press, London 1995; 191-203.

68. Schad H, Folwaczny H, Brechtelsbauer H, Birkenfeld G. The significance of respiration for thoracic duct flow in relation to other driving forces of lymph flow. Pflügers Arch 1978; 378:121-126.

69. Aarli V, Reed RK, Aukland K. Effect of longstanding venous stasis and hypoproteinemia on lymph flow in the rat tail. Acta Physiol Scand 1991; 142:1-9.

70. Pippard CJ, Roddie IC. Lymph flow in sheep limbs during local exposure to subatmospheric pressure. J Physiol Lond 1989; 419:45-57.

71. Fairman RP, Glauser FL, Falls R. Increases in lung lymph and albumin clearance with ethchlorvynol. J Appl Physiol 1981; 50:1151-115.

72. Fjeld MB, Kluge TH, Stokke KT, Skrede S. The effect of generalized hypoxia upon flow and composition of cardiac lymph in the dog. 1976; 6:255-259.

73. Leeds S, Uhley HN, Sampson JJ, Friedman M. The cardiac lymphatics after ligation of the coronary sinus. Proc Soc Exp Biol Med 1970; 135:59-62.

74. Michael LH, Lewis RM, Brandon TA, Entman ML. Cardiac lymph flow in conscious dogs. Am J Physiol 1979; 237:H311-H317.

75. Miller AJ. The lymphatics of the heart. Arch Int Med 1963; 112:501-511.

76. Reddy HK, Sigusch H, Zhou G, Tyagi SC, Janicki JS, Weber KT. Coronary vascular hyperpermeability and angiotensin II. J Lab Clin Med 1995; 126:307-315.

77. Ullal SR. Cardiac lymph and lymphatics. Experimental observations and clinical significance. Ann Roy Coll Surg Engl 1972; 51:282-298.

78. Laine GA. Microvascular changes in the heart during chronic arterial hypertension. Circ Res 1988; 62:953-960.

79. Michael LH, Hunt JR, Weilbaecher D, Perryman MB, Roberts R, Lewis RM, Entman ML. Creatine kinase and phosphorylase in cardiac lymph: Coronary occlusion and reperfusion. Am J Physiol 1985; 248:H350-H359.

80. Spieckermann PG, Nordbeck H, Knoll D, Kohl FV, Sakai K, Bretschneider HJ. Bedeutung der Herzlymphe für den Enzymtransport ins Blut beim Myokardinfarkt. Dtsch Med Wochenschr 1974; 99:1143-1144.

81. Szabo G, Magyar Z, Reffy A. Lymphatic transport of enzyme after experimental myocardial infarction. Lymphology 1974; 7:37-44.

82. Hargens AR, Zweifach BW. Transport between blood and peripheral lymph in intestine. Microvasc Res 1976; 11:89-101.

83. Knox P, Pflug JJ. The effect of the canine popliteal node on the composition of lymph. J Physiol London 1983; 345:1-14.

84. Quin JW, Shannon AD. The effect of anaestesia and surgery on lymph flow, protein and leukocyte concentration in lymph of the sheep. Lymphology 1975; 8:126-135.

85. Adair TH, Moffat DS, Paulsen AW, Guyton AC. Quantitation of changes in lymph protein concentration during lymph node transit. Am J Physiol 1982; 243:H351-H359.

86. Ludwig LL, Schertel ER, Pratt JW, McClure DE, Ying AJ, Heck CF, Myerowitz PD. Impairment of left ventricular function by acute cardiac lymphatic obstruction. Cardiovasc Res 1997; 33:164-171.

87. Gloviczki P, Solti F, Szlavy L, Jellinek H. Ultrastructural and electrophysiological changes of experimental acute lymphostasis. Lymphology 1983; 16:185-192.

88. Guski H, Buntrock P, Braselmann H, Marx I. The effect of lymphostasis on the isolated working rat heart. 1974; 30:1452-1455.

89. Sun SC, Lie JT. Cardiac lymphatic obstruction; ultrastructure of acute-phase myocardial injury in dogs. Mayo Clin Proc 1977, 52:785-792.

90. Miller AJ, Pick R, Katz LN. Ventricular endomyocardial changes after impairment of cardiac lymph flow in dogs. Br Heart J 1963; 25:182-190.

91. Symbas PN, Schlant RC, Gravanis MB, Shepherd RL. Pathologic and functional effects on the heart following interruption of the cardiac lymph drainage. J Thorac Cardiovasc Surg

1969; 57:577-584.

92. Witte CL, Witte MH, Dumont AE. Pathophysiology of chronic edema, lymphedema, and fibrosis. In: Edema. Edts.: Staub NC, Taylor AE. Raven Press, New York. 1984; 521-542.

93. McKinney B. Endocardial changes produced in Patus monkeys by the ablation of cardiac lymphatics and the administration of a plantain diet. Am Heart J 1976; 91:484-491.

94. Symbas PN, Cooper T, Gantner GA, Willman VL. Lymphatic drainage of the heart: Effects of experimental interruption of lymphatics. Surg Forum 1963; 14:254-256.

95. Solti F, Lengyel E, Jellinek H, Schneider F, Juhasz-Nagy A, Kekesi V. Coronary arteriopathy after lymphatic blockade: An experimental study in dogs. Lymphology 1994; 27:173-180.

96. Solti F, Nemeth V, Juhasz-Nagy A. Effect of acute cardiac lymph stasis on metabolic coronary adaptation in the dog. Lymphology 1985; 18:136-142.

97. Földi M, Romhanyi G, Rusznyak I, Solti F, Szabo G. Über die Insuffizienz der Lymphströmung im Herzen. Acta Med Acad Sci Hung 1954; 6:61-75.

98. Jacobs G, Kleinschmidt F, Benesch L, Lenz W, Uhlig G, Huth F. Tierexperimentelle Untersuchungen des kardialen Lymphgefäss-systems. Thoraxchirurgie 1976; 24:453-467.

99. Miller AJ, Pick R, Katz LN. Ventricular endomyocardial pathology produced by chronic cardiac lymphatic obstruction. Circ Res 1960; 8:941-947.

100. Ullal SR, Kluge TH, Gerbode F. Functional and pathologic changes in the heart following chronic cardiac obstruction. Surgery 1972; 71:328-334.

101. Laine GA. Change in (dP/dt)max as an index of myocardial microvascular permeability. Circ Res 1987; 61:203-208.

102. Heimisch W, Mohl W, Mendler N. Intermittent coronary sinus occlusion: effects on regional function of the normal and ischemic myocardium. In: The coronary sinus. Mohl W, Wolner E, Glogar D (eds). Steinkopff, Darmstadt 1984; 465-472.

Was this article helpful?

0 0
Reducing Blood Pressure Naturally

Reducing Blood Pressure Naturally

Do You Suffer From High Blood Pressure? Do You Feel Like This Silent Killer Might Be Stalking You? Have you been diagnosed or pre-hypertension and hypertension? Then JOIN THE CROWD Nearly 1 in 3 adults in the United States suffer from High Blood Pressure and only 1 in 3 adults are actually aware that they have it.

Get My Free Ebook


Post a comment