The Effects of Hemorrhagic Shock on the Heart

  • Donald B. Hackel
  • N. B. Ratliff
  • E. Mikat
  • T. Graham
Part of the Advances in Experimental Medicine and Biology book series (AEMB, volume 241)


It has become abundantly clear that shock produced by hemorrhage, as well as by other means, is a multisystem disease involving cells of many organs (1). It is apparent, therefore, that no one organ system need be implicated as the “weak link” which, if strengthened, would prevent irreversibility after transfusion since there are many alternative vicious cycles that can lead to death. However, it is our contention that the heart is significantly damaged during the course of a shock episode, and that this damage is severe enough to lead to a functional defect. There is impressive physiologic and anatomic evidence that this probably is a major contributing factor to irreversibility in most instances.


Hemorrhagic Shock Myocardial Contractility Hypovolemic Shock Sympathetic Stimulation Contractile Element 


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  1. 1.
    Rothe, C.F.: Heart failure and fluid loss in hemorrhagic shock. Fed. Proc. 29: 1854–1860, 1971.Google Scholar
  2. 2.
    Wiggers, C.F.: Physiology of Shock. Commonwealth Fund, N.Y., 1950, Chapter X.Google Scholar
  3. 3.
    Van Noate, H.F.: Right and left atrial pressures in successive stages of oligemic and normovolemic shock. Proc. Soc. Exper. Biol, and Med. 76: 155–159, 1951.Google Scholar
  4. 4.
    Gomez, O.A. and W.F. Hamilton: Functional cardiac deterioration during development of hemorrhagic circulatory deficiency. Circ. Res. 14: 327–336, 1964.PubMedGoogle Scholar
  5. 5.
    Crowell, J.W. and A.C. Guyton: Further evidence favoring a cardiac mechanism in irreversible hemorrhagic shock. Am. J. Physiol. 203: 248–252, 1962.PubMedGoogle Scholar
  6. 6.
    Cooley, J.C. and M.S. Mcintosh: Myocardial contractile force in experimental hemorrhagic shock. Arcn. Surg. 87: 330–340, 1963.CrossRefGoogle Scholar
  7. 7.
    Lefer, A.M., G.B. Craddock, R. Cowgill, and E.D. Brand: Performance of papillary muscles isolated from cats in post- oligemic shock. Am. J. Physiol. 211: 687–692, 1966.PubMedGoogle Scholar
  8. 8.
    Weidner, M.G., M.A. Albrecht and G.H.A. Clowes: Relationship of myocardial function in survival after oligemic hypotension. Surgery 55: 73–84, 1964.PubMedGoogle Scholar
  9. 9.
    Sarnoff, S.J., R.B. Case, P.E. Waithe and J.P. Isaacs: Insufficient coronary flow and myocardial failure as a complicating factor in late hemorrhagic shock. Am. J. Physiol. 176: 439–446, 1954.PubMedGoogle Scholar
  10. 10.
    Albert, H.M., B.A. Glass and R.L. Carter: The role of the heart in shock. The Am. Surgeon 34: 48–52, 1968.Google Scholar
  11. 11.
    Golden, P.F. and J.A. Jane: Survival following profound hypovolemia: role of heart, lung and brain. J. Trauma 9: 784–798, 1969.PubMedCrossRefGoogle Scholar
  12. 12.
    Ratliff, N.B., D.B. Hackel and E. Mikat: Myocardial carbohydrate metabolism and lesions in hemorrhagic shock. Effects of hyperbaric oxygen. Arch. Pathol. 88: 470–475, 1969.PubMedGoogle Scholar
  13. 13.
    Siegel, H.W. and S.E. Downing: Reduction of left ventricular contractility during acute hemorrhagic shock. Am. J. Physiol. 218: 772–779, 1970.PubMedGoogle Scholar
  14. 14.
    Siegel, H.W. and S.E. Downing: Contributions of coronary perfusion pressure, metabolic acidosis and adrenergic factors to the reduction of myocardial contractility during hemorrhagic shock in the cat. Circ. Res. 27: 875–889, 1970.PubMedGoogle Scholar
  15. 15.
    Hackel, D.B. and W.T. Goodale: Effects of hemorrhagic shock on the heart and circulation of intact dogs. Circ. 11: 628–634, 1955.Google Scholar
  16. 16.
    Hackel, D.B., and B.N. Catchpole: Pathological and electrocardiographic effects of hemorrhagic shock in dogs treated with 1-norepinephrine. Lab. Invest. 7: 358–368, 1958.PubMedGoogle Scholar
  17. 17.
    Martin, A.M. and D.B. Hackel: The myocardium of the dog in hemorrhagic shock. A histochemical study. Lab. Invest. 12: 77–91, 1963.Google Scholar
  18. 18.
    Martin, A.M., D.B. Hackel and S.M. Kurtz: The ultrastructure of zonal lesions of the myocardium in hemorrhagic shock. Am. J. Pathol. 44: 127–140, 1964.PubMedGoogle Scholar
  19. 19.
    Hackel, D.B., A.M. Martin, M.S. Spach and H.O. Sieker: Hemorrhagic shock in dogs. Relation of hemodynamic and meta¬bolic changes to myocardial lesions. Arch. Pathol. 77: 575–581, 1964.PubMedGoogle Scholar
  20. 20.
    Martin, A.M. and D.B. Hackel: An electron microscopic study of the progression of myocardial lesions in the dog after hemorrhagic shock. Lab. Invest. 15: 243–260, 1966.PubMedGoogle Scholar
  21. 21.
    Entman, M.L., D.B. Hackel, A.M. Martin, E. Mikat and J. Chang: Prevention of myocardial lesions during hemorrhagic shock in dogs by pronethalol. Arch. Pathol. 83: 392–395, 1967.PubMedGoogle Scholar
  22. 22.
    Ratliff, N.B., D.B. Hackel and E. Mikat: The effect of hyperbaric oxygen on the myocardial lesions of hemorrhagic shock in dogs. Am. J. Pathol. 51: 341–349, 1967.PubMedGoogle Scholar
  23. 23.
    Martin, A.M., D.B. Hackel, M.L. Entman, M.P. Capp and M.S. Spach: Mechanisms in the development of myocardial lesions in hemorrhagic shock. Ann. N.Y. Acad. Sci. 156: 79–90, 1969.PubMedCrossRefGoogle Scholar
  24. 24.
    Ratliff, N.B., D.B. Hackel and E. Mikat: Myocardial oxygen metabolism and myocardial blood flow in dogs in hemorrhagic shock. Circ. Res. 24: 901–909, 1969.PubMedGoogle Scholar
  25. 25.
    Chang, J. and D.B. Hackel: Comparative study of the myocardial lesions in hemorrhagic shock. In Preparation.Google Scholar
  26. 26.
    Martin, A.M., W.B. Green, R.L. Simmons, and H.B. Soloway. Human myocardial zonal lesions. Arch. Pathol. 87: 339–342, 1969.Google Scholar
  27. 27.
    Reichenbach, D.D. and E.P. Benditt: Myofibrillar degeneration. A response of the myocardial cell to injury. Arch. Pathol. 85: 189–199, 1968.PubMedGoogle Scholar
  28. 28.
    Klouda, M.A. and G. Brynjolfsson: Cardiotoxic effects of electrical stimulation of the stellate ganglia. Ann. N.Y. Acad. Sci. 156: 271–280, 1969.PubMedCrossRefGoogle Scholar
  29. 29.
    Szakacs, J.E. and A. Cannon: L-norepinephrine myocarditis. Am. J. Clin. Path. 30: 425–434, 1958.PubMedGoogle Scholar
  30. 30.
    Ferrans, V.J., R.G. Hibbs, J.J. Walsh and G.E. Burch: Histochemical and electron microscopical studies on the cardiac necrosis produced by sympathomimetic agents. Ann. N.Y. Acad. Sci. 156: 309–332, 1969.PubMedCrossRefGoogle Scholar
  31. 31.
    Light, F.W. and S.C. Benbrook: Subendocardial hemorrhages of the left ventricle following trauma in goats. Arch. Pathol. 65: 407–414, 1958.Google Scholar
  32. 32.
    Hiott, D.W.: Ultrastructural changes in heart muscle after hemorrhagic shock and isoproterenol infusions. Arch. Int. Pharmacodyn. et de Ther. 180: 206–216, 1969.PubMedGoogle Scholar
  33. 33.
    Graham, T.G. and Hackel, D.B.: Unpublished observations.Google Scholar
  34. 34.
    Martin, A.M., D.B. Hackel, M.S. Spach, M.P. Capp and E. Mikat: Cineangiocardiography in hemorrhagic shock. Am. Heart J. 69: 283–284, 1964.CrossRefGoogle Scholar
  35. 35.
    Hackel, D.B., A.M. Martin, M.P. Capp, M.J. Spach and E. Mikat: Effect of pronethalol on left ventricular volumes of dogs during hemorrhagic shock. Am. J. Pathol. 60: 93–101, 1970.PubMedGoogle Scholar
  36. 36.
    Langer, G.A.: Ion fluxes in cardiac excitation and contraction and their relation to myocardial contractility. Physiol. Rev. 48: 708–757, 1968.PubMedGoogle Scholar
  37. 37.
    Ratliff, N.B., P.T. Cruz and D.B. Hackel: Electrolytes and myocardial lesions in hemorrhagic shock. In preparation.Google Scholar
  38. 38.
    Luttgau, H.C. and R. Niedergerke: The antagonism between Ca and Na ions on the frog’s heart. J. Physiol. 143: 486–505, 1958.PubMedGoogle Scholar
  39. 39.
    Manery, J.F.: Water and electrolyte metabolism. Physiol. Rev. 34: 334–417, 1954.PubMedGoogle Scholar
  40. 40.
    Jennings, R.B., H.M. Sommers, P.B. Herdson and J.P. Kaltenbach: Ischemic injury of myocardium. Ann. N.Y. Acad. Sci. 156: 61–78 1969.PubMedCrossRefGoogle Scholar
  41. 41.
    Trump, B.F. and R.E. Bulger: Studies on cellular injury in isolated flounder tubules. III. Light microscopic and functional observations on laterations in tubules treated with cyanide. Lab. Invest. 18: 721–730, 1968.PubMedGoogle Scholar
  42. 42.
    Caldwell, P.C.: Factors governing movement and distribution of inorganic ions in nerve and muscle. Physiol. Rev. 48: 1–64, 1968.PubMedGoogle Scholar
  43. 43.
    Nayler, W.G.: Calcium exchange in cardiac muscle: A basic mechanism of drug action. Am. Heart J. 73: 379–394, 1967.PubMedCrossRefGoogle Scholar
  44. 44.
    Niedergerke, R.: Movements of Ca in beating ventricles of the frog heart. J. Physiol. 167: 551–580, 1963.PubMedGoogle Scholar

Copyright information

© Plenum Press, New York 1972

Authors and Affiliations

  • Donald B. Hackel
    • 1
  • N. B. Ratliff
    • 1
  • E. Mikat
    • 1
  • T. Graham
    • 1
  1. 1.Department of PathologyDuke University Medical CenterDurhamUSA

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