poem

The great Dr Starling, in his Law of the Heart

Said the output was greater if, right at the start,

The cardiac fibres were stretched a bit more,

So their force of contraction would be more than before.

Thus the larger the volume in diastole

The greater the output was likely to be.

If the right heart keeps pumping more blood than the left,

The lung circuit's congested; the systemic bereft.

Since no one is healthy with pulmo-congestion,

The Law of Doc Starling's a splendid suggestion.

The balance of outputs is made automatic

And blood-volume partition becomes steady-static.

When Guardsmen stand still and blood pools in their feet

Frank-Starling mechanics no longer seem neat.

The shift in blood volume impairs C-V-P,

Which shortens the fibres in diastole.

Contractions grow weaker and stroke volume drops,

Depresseing blood pressure; so down the Guard flops.

But when the heart reaches a much larger size,

This leads to heart failure, and often demise.

The relevant law is not Starling's, alas,

But the classical law of Lecompte de Laplace.

Your patient is dying in decompensation,

So reduce his blood volume or call his relation.

-Professor Alan Burton (1972)