Abstract
Skeletal muscle function was measured as force production and fatigue in both the quadriceps (a large locomotive muscle) and adductor pollicis (a small intrinsic hand muscle) in five healthy volunteers, five patients with mild chronic heart failure, and five patients with severe chronic heart failure. The quadriceps of patients with chronic heart failure had a reduced muscle cross sectional area, a reduced maximum isometric force production, and an increased tendency to fatigue. Isometric force production and fatigue of the adductor pollicis, however, were not significantly different between the three groups under control conditions. But during circulatory occlusion fatigue in the adductor pollicis increased more in the patients with severe chronic heart failure. These differing findings in quadriceps and adductor pollicis suggest that skeletal muscle atrophy and reduced isometric force production are not a necessary consequence of chronic heart failure per se, because they were only present in the large locomotive muscle. The normal values for muscle fatigue observed in adductor pollicis in patients with chronic heart failure imply that skeletal muscle blood flow must increase normally during muscle activation when only a small muscle mass is used. These results are not compatible with the concept of a generalised impairment of normal vasodilatation within active skeletal muscle. In contrast, activation of a large muscle, such as quadriceps, results in the rapid onset of fatigue in patients with severe chronic heart failure. This fatigue may be related to the inability of the cardiovascular system to provide the required blood flow for the activation of a large muscle mass. The finding of a relatively greater increase in fatigue of adductor pollicis during circulatory occlusion in patients with severe chronic heart failure supports the hypnosis of an intrinsic abnormality of skeletal muscle in these patients.
Full text
PDF
Selected References
These references are in PubMed. This may not be the complete list of references from this article.
- Edwards R. H., Round J. M., Jones D. A. Needle biopsy of skeletal muscle: a review of 10 years experience. Muscle Nerve. 1983 Nov-Dec;6(9):676–683. doi: 10.1002/mus.880060910. [DOI] [PubMed] [Google Scholar]
- Jones D. A., Round J. M., Edwards R. H., Grindwood S. R., Tofts P. S. Size and composition of the calf and quadriceps muscles in Duchenne muscular dystrophy. A tomographic and histochemical study. J Neurol Sci. 1983 Aug;60(2):307–322. doi: 10.1016/0022-510x(83)90071-0. [DOI] [PubMed] [Google Scholar]
- Lipkin D. P., Jones D. A., Round J. M., Poole-Wilson P. A. Abnormalities of skeletal muscle in patients with chronic heart failure. Int J Cardiol. 1988 Feb;18(2):187–195. doi: 10.1016/0167-5273(88)90164-7. [DOI] [PubMed] [Google Scholar]
- Wiener D. H., Fink L. I., Maris J., Jones R. A., Chance B., Wilson J. R. Abnormal skeletal muscle bioenergetics during exercise in patients with heart failure: role of reduced muscle blood flow. Circulation. 1986 Jun;73(6):1127–1136. doi: 10.1161/01.cir.73.6.1127. [DOI] [PubMed] [Google Scholar]
- Wilson D. F., Erecińska M., Drown C., Silver I. A. The oxygen dependence of cellular energy metabolism. Arch Biochem Biophys. 1979 Jul;195(2):485–493. doi: 10.1016/0003-9861(79)90375-8. [DOI] [PubMed] [Google Scholar]
- Wilson J. R., Ferraro N. Exercise intolerance in patients with chronic left heart failure: relation to oxygen transport and ventilatory abnormalities. Am J Cardiol. 1983 May 1;51(8):1358–1363. doi: 10.1016/0002-9149(83)90312-0. [DOI] [PubMed] [Google Scholar]
- Wilson J. R., Fink L., Maris J., Ferraro N., Power-Vanwart J., Eleff S., Chance B. Evaluation of energy metabolism in skeletal muscle of patients with heart failure with gated phosphorus-31 nuclear magnetic resonance. Circulation. 1985 Jan;71(1):57–62. doi: 10.1161/01.cir.71.1.57. [DOI] [PubMed] [Google Scholar]
- Wilson J. R., Martin J. L., Ferraro N. Impaired skeletal muscle nutritive flow during exercise in patients with congestive heart failure: role of cardiac pump dysfunction as determined by the effect of dobutamine. Am J Cardiol. 1984 May 1;53(9):1308–1315. doi: 10.1016/0002-9149(84)90085-7. [DOI] [PubMed] [Google Scholar]
- Wilson J. R., Martin J. L., Schwartz D., Ferraro N. Exercise intolerance in patients with chronic heart failure: role of impaired nutritive flow to skeletal muscle. Circulation. 1984 Jun;69(6):1079–1087. doi: 10.1161/01.cir.69.6.1079. [DOI] [PubMed] [Google Scholar]
- Zelis R., Flaim S. F. Alterations in vasomotor tone in congestive heart failure. Prog Cardiovasc Dis. 1982 May-Jun;24(6):437–459. doi: 10.1016/0033-0620(82)90012-3. [DOI] [PubMed] [Google Scholar]