May 1, 1997Current Opinion in Cardiology
Mechanisms and implications of autonomic nervous system dysfunction in heart failure
Population
Patients with heart failure and animal models of heart failure
Design
Review
Authors
Discussion
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Member takes
Implication
May support early baroreflex-targeted therapies in HF; leaves open prospective validation of clinical impact.
Key Points
- To elucidate the physiological mechanisms, stepwise progression, and clinical implications of sympathetic nervous system dysfunction and neurohumoral activation in heart failure.
- Narrative synthesis of clinical and experimental evidence detailing autonomic reflex control, hormonal signaling cascades, and central nervous system triggers in heart failure pathogenesis.
- Sympathetic dysregulation begins early due to attenuated cardiac and arterial baroreceptor reflexes, initiating an organ-specific response that impacts the heart before peripheral tissues.
- Neurohumoral activation progresses stepwise: resistance to atrial natriuretic peptide and intense sympathetic surge mark the shift to overt failure, followed by renin-angiotensin-aldosterone system activation.
- Sympathetic hyperactivity is further sustained by sensitized muscle metaboreceptors, increased peripheral chemoreceptor sensitivity, and central brain ouabainlike activity.
Structured PICO
P
Population
Patients with heart failure and animal models of heart failure
This review highlights the stepwise progression of neurohumoral activation in heart failure, emphasizing the potential of therapies that interrupt or reverse this autonomic dysfunction.
Cite This Study
Holly R. Middlekauff (1997) studied this question.