Origin of Symptoms in Heart Failure

摘要

In heart failure, the cardinal symptoms of breathlessness, reduced exercise capacity and muscle fatigue bear little correlation to conventional measures of left ventricular function or central haemodynamics. They are associated with objective abnormalities in ventilation, autonomic nervous system control and muscle metabolism, but controversies exist on the origin of these symptoms. Changes in the periphery may be partly responsible for the maintenance of sympatho-excitation and other neuro-hormonal activation and therefore may play a role in the progression of the syndrome. This paper reviews some of the abnormalities that can occur secondarily in cardiac and extra- cardiac systems during heart failure and explains how they may contribute to exercise limitation and be harmful during the progression of the syndrome. The clinical and therapeutic implications are also discussed.