title: Exercise intolerance in chronic heart failure: mechanisms and therapies. Part II.
abstract: Muscular fatigue and dyspnoea on exertion are among the most common symptoms in chronic heart failure; however their origin is still poorly understood. Several studies have shown that cardiac dysfunction alone cannot fully explain their origin, but the contribution of the multiorgan failure present in this syndrome must be highlighted. We aimed to summarize the existing evidence and the most controversial aspects of the complex interplay of different factors involved in the symptom generation. In the first part of the review, six key factors were revised (the heart, the lung, the skeletal muscle, the hormonal changes, the O2 delivery to the periphery, the endothelium). In this second part, the role of the excitatory reflexes and the cardiac cachexia are presented. Finally, potential therapeutic implications are discussed here. We believe that a better knowledge of the pathophysiology of this syndrome may contribute to the management of the patients and to the improvement in their stress tolerance and quality of life.
authors.affiliation: Heart Failure Unit, Department of Cardiology, G da Saliceto Hospital, Piacenza, Emilia Romagna, Italy. m.piepoli@ausl.pc.it
authors.forename: Massimo F
authors.initials: MF
authors.lastname: Piepoli
authors.forename: Marco
authors.initials: M
authors.lastname: Guazzi
authors.forename: Giuseppe
authors.initials: G
authors.lastname: Boriani
authors.forename: Mariantonietta
authors.initials: M
authors.lastname: Cicoira
authors.forename: Ugo
authors.initials: U
authors.lastname: Corrà
authors.forename: Luciano
authors.initials: L
authors.lastname: Dalla Libera
authors.forename: Michele
authors.initials: M
authors.lastname: Emdin
authors.forename: Donato
authors.initials: D
authors.lastname: Mele
authors.forename: Claudio
authors.initials: C
authors.lastname: Passino
authors.forename: Giorgio
authors.initials: G
authors.lastname: Vescovo
authors.forename: Carlo
authors.initials: C
authors.lastname: Vigorito
authors.forename: Giovanni
authors.initials: G
authors.lastname: Villani
authors.forename: Piergiuseppe
authors.initials: P
authors.lastname: Agostoni
mesh_terms: D002100:Cachexia / Q000209:etiology / Q000503:physiopathology; D058406:Cardiac Resynchronization Therapy; D002317:Cardiovascular Agents / Q000627:therapeutic use*; D002908:Chronic Disease; D004417:Dyspnea / Q000209:etiology / Q000503:physiopathology; D017079:Exercise Tolerance; D006333:Heart Failure / Q000097:blood / Q000150:complications / Q000503:physiopathology* / Q000628:therapy*; D006801:Humans; D009102:Multiple Organ Failure / Q000209:etiology / Q000503:physiopathology; D018763:Muscle Fatigue; D012018:Reflex; D016896:Treatment Outcome
chemical_list: D002317:Cardiovascular Agents