Key Points
- To outline the reflex adjustments of the peripheral circulation during chronic heart failure and describe their effects on cardiac loading conditions and myocardial performance.
- Physiological review synthesizing vascular and hemodynamic responses to elevated sympathetic outflow and circulating catecholamines in congestive heart failure.
- Increased sympathetic activity and circulating catecholamines produce severe vasoconstriction in renal, splanchnic, skeletal muscle, and cutaneous vascular beds, increasing cardiac afterload.
- Cutaneous venoconstriction combined with renal fluid retention elevates central venous pressure and preload, shifting the myocardium along its Starling curve and improving orthostatic tolerance.
- Because reflex peripheral vascular adjustments excessively augment both preload and afterload, vasodilator therapy targeting systemic veins or arterioles improves myocardial function.
Structured PICO
PPopulationPatients with congestive heart failure
IInterventionPharmacological agents causing dilatation of systemic veins and/or arterioles (vasodilators)
The review outlines the physiological basis for peripheral vasoconstriction in heart failure and supports the rationale for vasodilator therapy.