ABSTRACT
In our understanding of the mechanical performance of the heart as a pump we mostly rely on the famous studies of O tto Frank1 and Ernest Starling2 whose observations have been widely accepted for a century. Thus, the clinical therapeutic regimens contain volume substitution (preload), antihypertensive therapy (afterload), bradycardic agent (heart rate) and positive inotropic agent (contractility) drug administration. All these maneuvers involve the heart as a whole. In most of our patients, however, just parts of the ventricle are injured by insufficient energy supply. Therefore, if we treat the ventricle as a whole we may ask whether all the parts of the ventricle act in unison. When we look at heart preparations for morphological analyses (Fig. 5.1) it becomes obvious from the global as well as local anisotropy that there must be an inhomogeneity in myocardial contraction i) across the ventricular wall, ii) from site to site from apex to the base, and, moreover, iii) at any site along different angular orientations.
