The mechanisms of breathlessness in heart failure as the basis of therapy

PURPOSE OF REVIEW: The review provides an overview of recent understanding in relation to the mechanisms relating to skeletal muscle and the sympathetic nervous system, and therapies for breathlessness which target these mechanisms. These are set in the context of established knowledge in this field. RECENT FINDINGS: Despite strong evidence to support exercise training programmes, and recommendations in international guidelines, programmes are implemented poorly. Electrical stimulation appears to be a way of exercising people too frail to undertake a full exercise programme. There is evidence to support the use of opioids for breathlessness in other conditions, but as yet the evidence in chronic heart failure is mixed. SUMMARY: Previous work in relation to the role of skeletal muscle and sympathetic nervous system has set the scene for targeted therapies for the relief of breathlessness in people with heart failure.