Sympatho-excitation in heart failure is likely driven by an altered reflex system with nonuniform effects, as evidenced by increased muscle but not skin sympathetic nerve activity.
The finding that skin sympathetic nerve activity in contrast to muscle sympathetic nerve activity is not increased in heart failure supports the concept that an altered reflex system, such as the baroreflexes, with nonuniform effects on muscle and skin sympathetic nerve activity, underlies sympatho-excitation in heart failure.
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Middlekauff et al. (1994) studied this question.
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