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Congestive heart failure: pathophysiologic consequences of neurohormonal activation and the potential for recovery:
1Division of Cardiovascular Diseases, University of Tennessee Health Science Center, Memphis, 38163, USA.
Insights
Congestive heart failure (CHF) is often reversible. Evidence suggests that interventions can reverse neurohormonal activation, leading to recovery of heart and systemic tissues. CHF is not an irreversible disorder.
Area of Science:
- Cardiology
- Internal Medicine
- Pathophysiology
Background:
- Congestive heart failure (CHF) pathogenesis involves neurohormonal activation.
- This activation causes salt/water retention, leading to venous congestion.
- Systemic illness affecting soft tissues and bone can exacerbate CHF.
Purpose of the Study:
- To explore the potential for reversibility in congestive heart failure.
- To identify the underlying mechanisms that allow for recovery in CHF patients.
Main Methods:
- Review of evidence from interventions like bed rest, pharmaceuticals, and circulatory assist devices.
- Analysis of the role of neurohormonal systems in CHF pathophysiology and recovery.
Main Results:
- Evidence suggests CHF pathophysiologic consequences are reversible.
- Recovery potential exists for both cardiac and systemic tissues.
- Withdrawal of renin-angiotensin-aldosterone and adrenergic system activation is key.
Conclusions:
- Congestive heart failure should be viewed as a potentially reversible condition.
- Recovery is a reasonable expectation in CHF management.
- Reversing neurohormonal activation is fundamental to CHF recovery.
Abstract:
The congestive heart failure syndrome has its pathophysiologic origins rooted in neurohormonal activation, including hormone-mediated salt and water retention with ensuing central and systemic venous congestion. A systemic illness involving soft tissues and bone compounds this syndrome. Despite its complexity, however, many of these pathophysiologic consequences may prove reversible. Several lines of evidence, including responses to bed rest, pharmaceuticals and circulatory assist devices, suggest the potential for recovery exists and includes both the heart and systemic tissues. The fundamental basis on which the potential for recovery resides relates to withdrawal of responses and stimuli to activation of the renin-angiotensin-aldosterone and adrenergic nervous systems. Thus, a note of optimism would suggest congestive heart failure should no longer be considered an irreversible disorder. Instead, the potential for recovery must be considered as a reasonable expectation.
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