Abstract
Humoral systems play an important role in the pathophysiology and development of chronic heart failure (CHF). We conducted a search of neurohumoral activation in heart failure and its risk in the development of CHF. Neurohumoral factors may be divided into vasoconstrictive, vasodilative and cytokines. The main vasoconstrictive systems are the renin-angiotensin-aldosterone system (RAAS) and the sympathoadrenal system (SAS). Cytokines include tumour necrosis factor (TNF) alpha and interleukins. The systems of actions are interconnected and they mutually influence their secretion and activities. The possibilities of their detection and assessment for clinical purposes depend on their changes and kinetics in the organism and on the activity of individual metabolites. Apart from their vasoactive effects, the majority of humoral actions also interfere in the process of remodelling, function of the endothelium, blood elements, cardiomyocytes, cells of the smooth muscles, and in immunity as well as inflammatory processes. The rapid development of knowledge on the humoral actions in recent years has made possible their utilisation in diagnostics, treatment and prognosis.
Highlights
Humoral systems play an important role in the patophysiology and development of chronic heart failure (CHF)
The systems of actions are interconnected and they mutually influence their secretion and activities. The possibilities of their detection and assessment for clinical purposes depend on their changes and kinetics in the organism and on the activity of individual metabolites. Apart from their vasoactive effects, the majority of humoral actions interfere in the process of remodelling, function of the endothelium, blood elements, cardiomyocytes, cells of the smooth muscles, and in immunity as well as inflammatory processes
An increase in the level of atrial natriuretic peptide (ANP) as well as Brain natriuretic peptide (BNP) has been documented in patients with severe heart failure and normal systolic function, which could point to the fact that the diastolic dysfunction itself is sufficient for the activation of natriuretic peptides[17]
Summary
Humoral systems play an important role in the patophysiology and development of chronic heart failure (CHF). Vasopressin increases the effect of noradrenaline and angiotensin II: its main role is retention of water at the level of the distal tubule and the collecting tubules. Decrease in sodium reabsorption arteriodilatation venodilatation antiproliferation lusiotropic effect antifibrotic effect antiproliferation increase in vagal tone decrease in sympathetic activity decrease in renin activity decrease in aldosterone excretion dual activity: on the endothelial cell it leads to release of NO and prostaglandin I2 and to vasodilatation, while in the muscle cell it causes vasoconstriction, too[6].
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