Sympatho-Adrenal System in Congestive Heart Failure

  • P. K. Shah
Part of the Update in Intensive Care and Emergency Medicine book series (UICM, volume 6)

Abstract

Congestive heart failure is a common clinical syndrome with a complex pathophysiologic basis. The clinical syndrome is the end-result of a variety of cardiovascular diseases that alter contractile function, diastolic function, or the loading conditions of the heart. While the clinical severity of symptoms and effort intolerance in heart failure bear only an inconsistent relationship with global descriptors of ventricular function (ejection fraction, filling pressures, cardiac output), a fundamental disturbance in heart failure is inadequate tissue perfusion at rest and/or during exercise. A number of compensatory neurohumoral mechanisms are activated in heart failure in an attempt to preserve arterial perfusion pressure in the face of declining pump function but therein lies the paradox of heart failure. These some neurohumoral factors eventually contribute to the clinical and hemodynamic derangements that characterize the patient with heart failure. Some of these neurohumoral derangements may in fact contribute to morbidity and mortality in chronic heart failure.

Keywords

Dopamine Norepinephrine Cardiomyopathy Epinephrine Catecholamine 

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References

  1. 1.
    Chidsey CA, Harrison DC, Braunwald E (1962) Augmentation of the plasma norepinephrine response to exercise in patients with congestive heart failure. N Engl J Med 267: 650–654PubMedCrossRefGoogle Scholar
  2. 2.
    Thomas JA, Marks BH (1978) Plasma norepinephrine in congestive heart failure. Am J Cardiol 41: 233–243PubMedCrossRefGoogle Scholar
  3. 3.
    Francis GS, Goldsmith SR, Cohn JN (1982) Relationship of exercise capacity to resting left ventricular performance and basal plasma norepinephrine levels in patients with congestive heart failure. Am Heart J 104: 725–731PubMedCrossRefGoogle Scholar
  4. 4.
    Leimbach WN Jr, Wallin BG, Victor RG, et al (1986) Direct evidence from intraneural recordings for increased central sympathetic outflow in patients with heart failure. Circulation 73: 913–991PubMedCrossRefGoogle Scholar
  5. 5.
    Chidsey CA, Branwald E, Morrow AG, et al (1963) Myocardial norepinephrine concentration in man: effects of reserpine and of congestive heart failure. N Engl. J Med 269: 653–658PubMedCrossRefGoogle Scholar
  6. 6.
    Spann JF Jr, Chidsey CA, Pool PE, et al (1965) Mechanism of norepinephrine depletion in experimental heart failure produced by aortic constriction in the guinea pig. Circ Res 17: 312–321PubMedGoogle Scholar
  7. 7.
    Chidsey CA, Braunwald E, Morrow AG (1965) Catecholamine excretion and cardiac stores of norepinephrine in congestive heart failure. Am J Med 39: 442–451PubMedCrossRefGoogle Scholar
  8. 8.
    Pool PE, Covell JW, Levitt M, et al (1967) Reduction of cardiac tyrosine hydroxylase activity in experimental congestive heart failure: its role in the depletion of cardiac norepinephrine stores. Circ Res 20: 349–353PubMedGoogle Scholar
  9. 9.
    Covell JW, Chidsey CA, Braunwald E (1966) Reduction of the cardiac response to postganglionic sympathetic nerve stimulation in experimental heart failure. Circ Res 19: 51–56Google Scholar
  10. 10.
    Bristow MR, Ginsburg R, Minobe W, et al (1982) Decreased catecholamine sensitivity and beta-adrenergic receptor density in failing human hearts. N Engl J Med 307: 205–211PubMedCrossRefGoogle Scholar
  11. 11.
    Colucci WS, Alexander RW, Williams GH (1981) Decreased lymphocyte beta-adrenergicreceptor density in patients with heart failure and tolerance to the beta-adrenergic agonist pirbuterol. N Engl. J Med 305: 185–190PubMedCrossRefGoogle Scholar
  12. 12.
    Horn EM, Chow YK, Neuberg GW, et al (1986) The guanine nucleotide regulatory binding protein Ns is reduced in congestive heart failure (Abstr). Circulation 74 (Suppl II): 198Google Scholar
  13. 13.
    Francis GS, Goldsmith SR, Levine TB, et al (1984) The neurohumoral axis in congestive heart failure. Ann Intern Med 101: 370–377PubMedGoogle Scholar
  14. 14.
    Hermiller JB, Magorien RD, Leithe ME, et al (1983) Clonidine in congestive heart failure: a vasodilator with negative inotropic effects. Am J Cardiol 51: 791–795PubMedCrossRefGoogle Scholar
  15. 15.
    Gaffney TE, Braunwald E (1963) Importance of adrenergic nervous system in the support of circulatory function in patients with congestive heart failure. Am J Med 34: 320–324PubMedCrossRefGoogle Scholar
  16. 16.
    Epstein SE, Braunwald E (1966) The effect of beta adrenergic blockade on patterns of urinary sodium excretion: studies in normal subjects and in patients with heart disease. Ann Intern Med 65: 20–27PubMedGoogle Scholar
  17. 17.
    Francis GS (1985) Neurohumoral mechanisms involved in congestive heart failure. Am J Cardiol 55: 15AGoogle Scholar
  18. 18.
    Kline I (1961) Myocardial alterations associated with pheochromocytomas. Am J Pathol 38: 539PubMedGoogle Scholar
  19. 19.
    Van Vliet P, Burchell H, Titus J (1966) Focal myocarditis associated with pheochromocytoma. N Engl. J Med 274: 1102PubMedCrossRefGoogle Scholar
  20. 20.
    Szakacs J, Cannon A (1958) L-norepinephrine myocarditis. Am J Clin Pathol 30: 425PubMedGoogle Scholar
  21. 21.
    Cohn JN, Levine TB, Olivari MT, et al (1984) Plasma norepinephrine, as a guide to prognosis in patient with chronic congestive heart failure. N Engl J Med 311: 819–823PubMedCrossRefGoogle Scholar
  22. 22.
    Cohn JN, Rector T, Olivari MT, et al (1985) Plasma norepinephrine, ejection fraction and maximal oxygen consumption as prognostic variables in congestive heart failure (Abstr). Circulation 72 (Suppl III): 285Google Scholar
  23. 23.
    Dawson JR, Canepa-Anson R, Kuan P, et al (1983) Symptoms, haemodynamics, and exercise capacity during long term treatment of chronic heart failure: experience with pirbuterol. Br Heart J 50: 282–289PubMedCrossRefGoogle Scholar
  24. 24.
    Dies F, Krell MJ, Whitlow P et al (1986) Intermittent dobutamine in ambulatory outpatients with chronic cardiac failure (Abstr). Circulation 74 (Suppl II): 38Google Scholar
  25. 25.
    Weber KT, Andrews V, Janicki JS, et al (1982) Pirbuterol, an oral beta-adrenergic receptor agonist, in the treatment of cardiac failure. Circulation 66: 1262–1267PubMedCrossRefGoogle Scholar
  26. 26.
    Lambertz H, Meyer J, Erbel R (1984) Long-term hemodynamic effects of prenalterol in patients with severe congestive heart failure. Circulation 69: 298–305PubMedCrossRefGoogle Scholar
  27. 27.
    Roubin GS, Choong CY, Devenish-Meares S, et al (1984) Beta-adrenergic stimulation of the failing ventricle: a double-blind, randomized trial of sustained oral therapy with prenalterol. Circulation 69: 955–962PubMedCrossRefGoogle Scholar
  28. 28.
    Sharma B, Hoback J, Francis GS, et al (1981) Pirbuterol: a new oral sympathomimetic amine for the treatment of congestive heart failure. Am Heart J 102 (3 P12): 533–541PubMedCrossRefGoogle Scholar
  29. 29.
    Mettauer B, Rouleau JL, Burgess JH (1985) Detrimental arrhythmogenic and sustained beneficial hemodynamic effects of oral salbutamol in patients with chronic congestive heart failure. Am Heart J 109: 840–847PubMedCrossRefGoogle Scholar
  30. 30.
    Waagstein F, Hjalmarson A, Varnauskas E, et al (1975) Effect of chronic beta-adrenergic receptor blockade in congestive cardiomyopathy. Br Heart J 37: 1022–1036PubMedCrossRefGoogle Scholar
  31. 31.
    Swedberg K, Hjalmarson A, Waagstein F, et al (1979) Prolongation of survival in congestive cardiomyopathy by beta-receptor blockade. Lancet 1: 1374–1376PubMedCrossRefGoogle Scholar
  32. 32.
    Currie PJ, Kelly MJ, McKenzie A, et al (1984) Oral beta-adrenergic blockade with metoprolol in chronic severe dilated cardiomypathy. J Am Coll Cardiol 3: 203–209PubMedCrossRefGoogle Scholar
  33. 33.
    Ikram H, Fitzpatrick D (1981) Double-blind trial of chronic oral beta-blockade in congestive cardiomyopathy. Lancet 2: 490–493PubMedCrossRefGoogle Scholar
  34. 34.
    Anderson JL, Lutz JR, Gilbert EM, et al (1985) A randomized trial of low-dose beta-blockade therapy for idiopathic dilated cardiomyopathy. Am J Cardiol 55: 471–475PubMedCrossRefGoogle Scholar
  35. 35.
    Engelmeier RS, O’Connell JB, Walsh R, et al (1985) Improvement in symptoms and exercise tolerance by metoprolol in patients with dilated cardiomyopathy: a double-blind, randomized, placebo-controlled trial. Circulation 72: 536–546PubMedCrossRefGoogle Scholar

Copyright information

© Springer-Verlag Berlin Heidelberg 1988

Authors and Affiliations

  • P. K. Shah

There are no affiliations available

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