Mechanisms of neurohormonal activation in chronic congestive heart failure: pathophysiology and therapeutic implications.
Patients with chronic congestive heart failure have a sequential and incessant activation of those neurohormonal systems, which control body fluids, cardiac output and systemic blood pressure. Neurohormonal activation is initially selective and regional. Generalized activation is a late event in the natural history of congestive heart failure. Although the ultimate stimulus responsible for the activation of these neurohormonal systems is unknown, a decreased cardiac output and diminished effective blood volume have been proposed as the responsible mechanisms. However, extensive clinical and experimental research suggest that cardiac remodeling and loading of low-pressure cardiac receptors with sympathetic afferents could be the triggering events followed by unloading of high-pressure carotid receptors by decreased cardiac output and diminished effective blood volume.
Dávila
Diego F
DF
Instituto de Investigaciones Cardiovasculares, Universidad de Los Andes, Mérida, Venezuela. diegod@ula.ve
Núñez
Tulio J
TJ
Odreman
Rodolfo
R
de Dávila
Carmen A Mazzei
CA
D000319:Adrenergic beta-Antagonists / Q000627:therapeutic use*; D002316:Cardiotonic Agents / Q000627:therapeutic use*; D006333:Heart Failure / Q000188:drug therapy* / Q000378:metabolism / Q000503:physiopathology*; D006352:Heart Ventricles / Q000294:innervation / Q000503:physiopathology; D006728:Hormones / Q000502:physiology*; D006801:Humans; D018377:Neurotransmitter Agents / Q000502:physiology*; D015398:Signal Transduction / Q000187:drug effects / Q000502:physiology; D013564:Sympathetic Nervous System / Q000378:metabolism / Q000503:physiopathology; D014665:Vasodilator Agents / Q000627:therapeutic use*
D000319:Adrenergic beta-Antagonists; D002316:Cardiotonic Agents; D006728:Hormones; D018377:Neurotransmitter Agents; D014665:Vasodilator Agents