Low cardiac output state

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The heart is a simple mechanical pump

For this pump to work well it needs a good supply of fuel and oxygen and this is achieved through good blood supply. However, there is a second aspect which is largely ignored by cardiologists and other doctors. The heart needs to be able to convert this fuel and oxygen supply into a usable form of energy for the muscle cells to work. This is achieved by mitochondria. They take fuel and oxygen from the blood and through a complex series of biochemical reactions, including Kreb’s citric acid cycle and oxidative phosphorylation, they generate ATP, the currency of energy in the body. Each heart cell will hold between 2,000 – 3,000 mitochondria. The reason it needs so many is that the heart never gets a rest – it has to work 24/7! An interesting observation here is that the heart is rich in oxygen and mitochondria – when the latter gets switched off, this is a major risk factor for cancer. One never sees cases of primary cancer of the heart!

The heart is only responsible for 60% of blood pressure – the rest is achieved by the muscular arteries, which pick up the pressure wave generated by the heart and boost it. High blood pressure can certainly damage delicate lining of arteries and it is the repair process which causes arteriosclerosis, or hardening and narrowing of the arteries. Cholesterol is a central part of this repair process and is probably a symptom of damage to the arteries (i.e. a marker for damage), rather than the primary cause.

What goes wrong?

Heart failure is a symptoms of other things going wrong- the important thing is to identify those problems. They boil down to the following or a combination of the follow problems, in order of probability

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