Exercise intolerance in chronic heart failure: mechanisms and therapies. Part II

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...

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Published in:European journal of cardiovascular prevention and rehabilitation 2010-12, Vol.17 (6), p.643-648
Main Authors: Piepoli, Massimo F., Guazzi, Marco, Boriani, Giuseppe, Cicoira, Mariantonietta, Corrá, Ugo, Libera, Luciano Dalla, Emdin, Michele, Mele, Donato, Passino, Claudio, Vescovo, Giorgio, Vigorito, Carlo, Villani, Giovanni, Agostoni, Piergiuseppe
Format: Article
Language:English
Subjects:
Cachexia - etiology
Cachexia - physiopathology
Cardiac Resynchronization Therapy
Cardiovascular Agents - therapeutic use
Chronic Disease
Dyspnea - etiology
Dyspnea - physiopathology
Exercise Tolerance
Heart Failure - blood
Heart Failure - complications
Heart Failure - physiopathology
Heart Failure - therapy
Humans
Multiple Organ Failure - etiology
Multiple Organ Failure - physiopathology
Muscle Fatigue
Reflex
Treatment Outcome
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Summary: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.
ISSN:2047-4873
1741-8267
2047-4881
1741-8275
DOI:10.1097/HJR.0b013e32833f3aa5