Related Experiment Video

Updated: Jun 24, 2026

Benefits of Cardiac Resynchronization Therapy in an Asynchronous Heart Failure Model Induced by Left Bundle Branch Ablation and Rapid Pacing
12:45

Benefits of Cardiac Resynchronization Therapy in an Asynchronous Heart Failure Model Induced by Left Bundle Branch Ablation and Rapid Pacing

Published on: December 11, 2017

Sympathetic activation in congestive heart failure: evidence, consequences and therapeutic implications

Guido Grassi1, Gino Seravalle, Fosca Quarti-Trevano

  • 1Clinica Medica, Dipartimento di Medicina Clinica e Prevenzione, Università Milano-Bicocca, Ospedale San Gerardo di Tintori (Monza), Milan, Italy. guido.grassi@unimib.it

Current Vascular Pharmacology
|April 10, 2009
PubMed

Insights

Congestive heart failure (CHF) involves a hyperadrenergic state, impacting prognosis and treatment. Understanding sympathetic nervous system changes is crucial for managing heart failure and preventing adverse outcomes.

Area of Science:

  • Cardiology
  • Neuroscience
  • Pharmacology

Background:

  • Congestive heart failure (CHF) presents with significant hemodynamic and sympathetic nervous system alterations.
  • These neurogenic changes are critical determinants of CHF prognosis and therapeutic targets.

Purpose of the Study:

  • To review the evidence for a hyperadrenergic state in CHF.
  • To explore the underlying causes and clinical consequences of sympathetic alterations in CHF.
  • To examine therapeutic strategies targeting sympathetic dysfunction in heart failure.

Main Methods:

  • Evidence synthesis from indirect (plasma norepinephrine, heart rate variability) and direct (microneurography, norepinephrine spillover, radioimaging) approaches.
  • Analysis of central, reflex, and metabolic factors contributing to sympathetic overactivity.
  • Review of clinical outcomes and therapeutic interventions related to sympathetic modulation.

Main Results:

  • A hyperadrenergic state is a recognized hallmark of CHF.
  • Sympathetic overdrive exacerbates disease progression, increases arrhythmia risk, and contributes to adverse outcomes, including sudden death.
  • Pharmacological and non-pharmacological interventions can modulate sympathetic abnormalities in heart failure.

Conclusions:

  • The hyperadrenergic state in CHF has profound clinical implications.
  • Targeting sympathetic nervous system dysfunction offers a promising therapeutic avenue for improving outcomes in heart failure patients.

Related Concept Videos

Heart Failure II: Pathophysiology01:29

Heart Failure II: Pathophysiology

Systolic Heart Failure and Compensatory MechanismsSystolic heart failure (also termed HFrEF, Heart Failure with Reduced Ejection Fraction) is the most prevalent type of heart filure. It results in a decreased volume of blood being pumped from the ventricle. The aortic arch and carotid sinuses have baroreceptors that detect reduced blood pressure, triggering the sympathetic nervous system (SNS) to release epinephrine and norepinephrine. Initially, this response aims to boost heart rate and...
Heart Failure Drugs: Inhibitors of Renin-Angiotensin System01:26

Heart Failure Drugs: Inhibitors of Renin-Angiotensin System

The activation of the sympathetic nervous system and the renin-angiotensin-aldosterone system (RAAS) contributes to cardiac remodeling, and inhibiting the RAAS is a pharmacological target in heart failure management. As a result, neurohumoral modulation is a crucial treatment principle for managing heart failure. This approach involves using medications like ACE inhibitors (ACEIs), angiotensin receptor blockers (ARBs), β-blockers, mineralocorticoid receptor antagonists (MRAs), and neutral...
Pathophysiology of Heart Failure01:17

Pathophysiology of Heart Failure

Heart failure (HF) is a progressive syndrome involving ventricles that leads to inadequate cardiac output. It can be classified based on location and output or ejection fraction. Ejection fraction (EF) is an essential measurement in the diagnosis and surveillance of HF. Reduced EF corresponds to systolic heart failure (HFrEF). However, HF with preserved ejection fraction (HFpEF) is becoming increasingly prevalent. Also known as diastolic HF, this form of HF is related to aging. The...
Heart Failure VI: Adjunct Therapies01:22

Heart Failure VI: Adjunct Therapies

Additional therapies for treating patients with heart failure (HF) may include procedural interventions, supplemental oxygen, the management of sleep disorders, and nutritional therapy.Procedural InterventionsImplantable Cardioverter-Defibrillator: For patients at risk of life-threatening arrhythmias due to severe left ventricular dysfunction, an Implantable Cardioverter-Defibrillator (ICD) can detect and terminate these arrhythmias, preventing sudden cardiac death and improving survival rates.
Heart Failure V: Medical Management01:30

Heart Failure V: Medical Management

Medical Management of Acute Decompensated Heart Failure (ADHF)The primary goals of therapy for patients hospitalized with acute decompensated heart failure (ADHF) include:Relieving symptomsOptimizing volume statusSupporting oxygenation and ventilationMaintaining cardiac output (CO) and end-organ perfusionIdentifying and addressing the cause of ADHFPreventing complicationsProviding patient education on factors precipitating HF exacerbationPlanning for dischargeOngoing monitoring and assessment...
Heart Failure Drugs: β-Blockers01:22

Heart Failure Drugs: β-Blockers

β-adrenergic antagonists, commonly known as β-blockers, block the effects of sympathetic neurotransmitters such as noradrenaline (NA) and adrenaline (ADR). They have several beneficial effects in heart failure treatment. They reduce heart rate, the force of contraction, and cardiac muscle relaxation. They also slow the atrial-ventricular conduction rate and raise the threshold for arrhythmias. The concentration of β-blockers determines their effects on bronchodilation, vasodilation, and...