Neurohormonal Influences in the Pathogenesis of Congestive Heart Failure

Abstract

Despite the interest in neurotransmitter and hormonal influences in heart failure in the last decade, the issues surrounding their contribution to the pathophysiology of congestive heart failure have become more complex. This must be considered in view of the pathway of hormonal stimulation and inhibition (Fig. 3) and the multiple steps where abnormal responses can interrupt these pathways. It is reasonable to state that the extent of neurotransmitter and hormonal activity in stage IV heart patients, treated with digoxin and diuretics, has been characterized. However, these observations cannot be extended to other stages of CHF, and assumptions cannot be made regarding either the untreated patient, or the nature of disease progression. Furthermore, there is insufficient information regarding the direct effect of these hormonal systems, with the exception of norepinephrine, on the myocardium. These issues must be the focus of future studies.