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Development of Heart Failure and the Role of the Autonomic Nervous System of the Heart

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Autonomic Innervation of the Heart

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Abstract

Heart failure is a clinical syndrome that develops in response of a cardiac insult, resulting in a decline of cardiac performance. Several neurohormonal mechanisms are activated in response to the underlying myocardial dysfunction, including the autonomic nervous system. Patients with heart failure are characterized by an abnormally activated sympathetic and altered parasympathetic tone, with also attenuated cardiovascular reflexes and a maladaptive downregulation of adrenergic nerve terminals. During exercise, an inappropriate rise in ventilation occurs as well as an enhanced peripheral vasoconstriction in order to preserve an adequate blood pressure level. Although the activation of these systems can initially compensate for the depressed myocardial function, their long-term activation results in a further impairment of cardiac function leading to progression of heart failure with fatigue and dyspnea being major barriers for exercise tolerance. Medication, in particular beta-blocker and ACE-inhibitor therapy, influences both the sympathetic and parasympathetic tone. The sympathetic tone may also be modulated by cardiac resynchronization therapy whereas vagus nerve stimulation may increase the parasympathetic activity. Through its impact on the periphery, physical exercise is also able to influence both the sympathetic and parasympathetic nervous system..

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Abbreviations

[123I]-MIBG:

Iodine-123 metaiodobenzylguanidine

ANS:

Autonomic nervous system

CNS:

Central nervous system

CO:

Cardiac output

CRT:

Cardiac resynchronization therapy

nNOS:

Neuronal nitric oxide synthase

NO:

Nitric oxide

PSNS:

Parasympathetic nervous system

RAAS:

Renin-angiotensin-aldosterone system

SNS:

Sympathetic nervous system

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Authors and Affiliations

  1. Department of internal medicine, Ghent University, Ghent, Belgium

    S. Pardaens MSc & J. De Sutter MD, PhD

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  1. S. Pardaens MSc
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  2. J. De Sutter MD, PhD
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Correspondence to S. Pardaens MSc .

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Editors and Affiliations

  1. Nuclear Medicine and Molecular Imaging, University Medical Center Groningen, Groningen, The Netherlands

    Riemer H.J.A. Slart

  2. Thorax center Cardiology, University Medical Center Groningen, Groningen, The Netherlands

    René A. Tio

  3. Nuclear Medicine and Molecular Imaging, University Medical Center Groningen, Groningen, The Netherlands

    Philip H. Elsinga

  4. Nuklearmedizinische Klinik, Klinikum Rechts der Isar Technische Universität München, München, Germany

    Markus Schwaiger

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Pardaens, S., De Sutter, J. (2015). Development of Heart Failure and the Role of the Autonomic Nervous System of the Heart. In: Slart, R., Tio, R., Elsinga, P., Schwaiger, M. (eds) Autonomic Innervation of the Heart. Springer, Berlin, Heidelberg. https://doi.org/10.1007/978-3-662-45074-1_3

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