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The Importance of Visceral Feedbacks: Focus on Chemoreceptors

Role of Peripheral and Central Sensors of Oxygen, Carbon Dioxide, and pH

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The Breathless Heart

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Abstract

Chronic heart failure (CHF) is characterized by a resetting of visceral feedbacks, with increased chemo- and ergoreflex sensitivities and reduced baroreflex sensitivity. The discharge rate of peripheral and/or central chemoreceptors may be enhanced in CHF, mostly due to neurohormonal stimulation and/or hypoperfusion of chemosensitive areas; increased chemoreceptor activity may contribute to the development of periodic breathing/Cheyne–Stokes respiration (PB/CSR), but also to sympatho-vagal imbalance, with adrenergic activation and vagal withdrawal. In addition, baroreflex depression and ergoreflex activation could be promoted by increased chemoreflex sensitivity and could contribute to autonomic dysfunction and ventilatory instability, although current evidences are limited.

In the present chapter, we will discuss the causes of enhanced chemoreflex sensitivity and the complex interplay among visceral feedbacks in the determinism of PB/CSR and the associated autonomic imbalance.

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Abbreviations

Ang II:

Angiotensin II

AT1R:

AG-II receptors type 1

BBB:

Blood–brain barrier

CB:

Carotid body

CHF:

Chronic heart failure

CNS:

Central nervous system

CRG:

Central respiratory generator

CSR:

Cheyne–Stokes respiration

HCVR:

Hypercapnic ventilatory response

HRV:

Heart rate variability

HVR:

Hypoxic ventilatory response

KLF2:

Kruppel-like factor 2

LVEF:

Left ventricular ejection fraction

NO:

Nitric oxide

nNOS:

Neuronal nitric oxide synthase

NREM:

Non-rapid eye movement

NST:

Nucleus of the solitary tract

NYHA:

New York Heart Association

O2 − :

Oxygen superoxide

PaCO2 :

Arterial partial pressure of carbon dioxide

PB:

Periodic breathing

VE/VCO2 slope:

Ventilation/carbon dioxide output slope

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Authors and Affiliations

  1. Division of Cardiology and Cardiovascular Medicine, Fondazione Toscana Gabriele Monasterio, Pisa, Italy

    Alberto Giannoni & Francesca Bramanti

  2. Institute of Life Sciences, Scuola Superiore Sant’Anna, Pisa, Italy

    Alberto Aimo

  3. Heart Failure Unit, Cardiac Department, Guglielmo da Saliceto Polichirurgico Hospital, AUSL, Piacenza, Italy

    Massimo F. Piepoli

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  1. Alberto Giannoni
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  2. Alberto Aimo
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  3. Francesca Bramanti
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  4. Massimo F. Piepoli
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Correspondence to Alberto Giannoni .

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Editors and Affiliations

  1. Fondazione Toscana Gabriele Monasterio, Pisa, Italy

    Michele Emdin

  2. Fondazione Toscana Gabriele Monasterio, Pisa, Italy

    Alberto Giannoni

  3. Fondazione Toscana Gabriele Monasterio, Pisa, Italy

    Claudio Passino

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Giannoni, A., Aimo, A., Bramanti, F., Piepoli, M.F. (2017). The Importance of Visceral Feedbacks: Focus on Chemoreceptors. In: Emdin, M., Giannoni, A., Passino, C. (eds) The Breathless Heart. Springer, Cham. https://doi.org/10.1007/978-3-319-26354-0_5

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