Cellular mechanisms in sympatho-modulation of the heart

Cardiovascular function relies on complex servo-controlled regulation mechanisms that involve both fast-acting feedback responses and long-lasting adaptations affecting the gene expression. The adrenergic system, with its specific receptor subtypes and intracellular signalling cascades provides the major regulatory system, while the parasympathetic system plays a minor role. At the molecular level, Ca(2+) acts as the general signal trigger for the majority of cell activities including contraction, metabolism and growth. During recent years, important new results have emerged allowing an integrated view of how the multifarious Ca(2+)-signalling mechanisms transmit adrenergic impulses to intracellular target sites. These insights into cellular and molecular mechanisms are pivotal in improving pharmacological control of the sympathetic responses to surgical trauma and perioperative stress. They are examined in detail in this review, with particular emphasis being given to the differences in intracellular signalling between cardiomyocytes and vascular smooth muscle cells.