The autonomic nervous system and heart failure

Research output: Contribution to journalReview article

180 Citations (Scopus)

Abstract

The pathophysiology of heart failure (HF) is characterized by hemodynamic abnormalities that result in neurohormonal activation and autonomic imbalance with increase in sympathetic activity and withdrawal of vagal activity. Alterations in receptor activation from this autonomic imbalance may have profound effects on cardiac function and structure. Inhibition of the sympathetic drive to the heart through β-receptor blockade has become a standard component of therapy for HF with a dilated left ventricle because of its effectiveness in inhibiting the ventricular structural remodeling process and in prolonging life. Several devices for selective modulation of sympathetic and vagal activity have recently been developed in an attempt to alter the natural history of HF. The optimal counteraction of the excessive sympathetic activity is still unclear. A profound decrease in adrenergic support with excessive blockade of the sympathetic nervous system may result in adverse outcomes in clinical HF. In this review, we analyze the data supporting a contributory role of the autonomic functional alterations on the course of HF, the techniques used to assess autonomic nervous system activity, the evidence for clinical effectiveness of pharmacological and device interventions, and the potential future role of autonomic nervous system modifiers in the management of this syndrome.

Original languageEnglish (US)
Pages (from-to)1815-1826
Number of pages12
JournalCirculation research
Volume114
Issue number11
DOIs
StatePublished - May 23 2014

Fingerprint

Autonomic Nervous System
Heart Failure
Equipment and Supplies
Ventricular Remodeling
Sympathetic Nervous System
Adrenergic Agents
Heart Ventricles
Hemodynamics
Pharmacology

Keywords

  • adrenergic
  • autonomic nervous system
  • heart failure
  • norepinephrine
  • receptors

Cite this

The autonomic nervous system and heart failure. / Florea, Viorel G.; Cohn, Jay N.

In: Circulation research, Vol. 114, No. 11, 23.05.2014, p. 1815-1826.

Research output: Contribution to journalReview article

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