Dávila DF, Núñez TJ, Odreman R, de Dávila CAM. Mechanisms of neurohormonal activation in chronic congestive heart failure: pathophysiology and therapeutic implications.
Int J Cardiol 2005;
101:343-6. [PMID:
15907399 DOI:
10.1016/j.ijcard.2004.08.023]
[Citation(s) in RCA: 36] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/18/2003] [Revised: 05/11/2004] [Accepted: 08/07/2004] [Indexed: 11/25/2022]
Abstract
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.
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