Abnormalities of the Autonomic Nervous System in Heart Failure

Abstract

The development and progression of heart failure is accompanied by numerous secondary responses that involve alterations in myocardial structure and function as well as a range of neuroendocrine changes. Many of the compensatory changes seem to become maladaptive perhaps contributing to heart failure progression. Profound changes in autonomic function are most notable, particularly heightened sympathetic nervous activity and altered reflex function. In this review, a description of methodologies presently used to characterize these disturbances in human (as well as experimental) heart failure is provided, and the autonomic pathophysiology of heart failure is reviewed. Data presented in this review also indicate a clear relationship between sympathetic tone and survival in heart failure patients. In particular, recent data point to the important role that cardiac sympathetic activation may play in disease prognosis. Despite clear progress in our understanding of the genesis of these disturbances in cardiac failure, further information regarding the initiation and development of disturbed autonomic function is required to allow improved therapeutic approaches to be formulated in the management of heart failure.