Our tortuous heart in dynamic mode--an echocardiographic study of mitral flow and movement in exercising subjects

Blood traces tortuous paths of flow through the heart. We postulate that momentum changes associated with direction changes optimize dynamic coupling between ventricular and atrial function, particularly on exercise. Traces of pulsed Doppler mitral flow and M-mode long-axis mitral ring movement were recorded before and during exercise, increased in 25-W steps to strenuous levels (146 +/- 30 W), in 16 healthy volunteers, aged 38 +/- 10 years. R-R intervals fell from 821 +/- 151 to 437 +/- 51 ms, and diastole from 458 +/- 134 to 169 +/- 33 ms. Peak mitral flow velocities rose from 0.68 +/- 0.17 to 1.27 +/- 0.16 m/s, and mitral valve ring displacements from 13.8 +/- 3.3 to 19.3 +/- 3.4 mm. Biphasic diastolic curves of flow and movement became monophasic as R-R fell below 500 ms, with atrial systole apparently coming to coincide with elastic ventricular recoil to give a single elevated peak of mitral flow. The increased slope and amplitude of Doppler curves indicate increased rates of change of momentum, which imply enhanced inertial forces. The illustrated patterns of flow and movement on exercise accord with the postulated "dynamic" mode of function, in which forces between atria, ventricles, and passing blood masses become tightly coupled to achieve a sling-like redirection of momentum through tortuous paths of flow, but more extensive data are needed to adequately model and quantify inertial force exchanges of the exercising heart.