[Peripheral vascular remodelling and changes to the skeletal muscles in heart failure]

The syndrome of heart failure causes besides a deterioration in the contractile function of the heart significant alterations of peripheral circulation and skeletal muscles. The distribution of the regional blood flow is influenced by systemic and local neurohumoral factors. The local factors are released by the vascular endothelium or are of nonendothelial origin. The diminution of cardiac output leads to neurohumoral alterations which eventually influence the blood flow distribution: in vital organs, such as the heart and the brain, it is preserved; in the splanchnic, kidney, muscle and skin territories it is diminished. Muscles changes (muscle atrophy, reduction of type I fibres and a relative increase of type IIb fibres) are the main cause restricting the exercise. Techniques of physical rehabilitation associated with proper medication may lead to the improvement of these alterations.