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

• 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
• ISSN: 2047-4873; 1741-8267; 2047-4881; 1741-8275
• DOI: 10.1097/HJR.0b013e32833f3aa5

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.