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(Circulation. 2004;110:2978-2979.)
© 2004 American Heart Association, Inc.

Editorial

Congestive Heart Failure

More Bad News From Exercising Muscle?

Michael J. Joyner, MD

From the Department of Anesthesiology, Mayo Clinic, Rochester, Minn.

Correspondence to Dr Michael J. Joyner, Department of Anesthesiology, Mayo Clinic, 200 1st St SW, Rochester, MN 55905. E-mail joyner.michael@mayo.edu

Key Words: Editorials • exercise • heart failure • nervous system, sympathetic

An extract of the first 250 words of the full text is provided, because this article has no abstract.

A hallmark of congestive heart failure (CHF) is exercise intolerance.^1–5 In this context, CHF can cause exercise-limiting changes in every key step in the oxygen transport system. For example:

• The lungs can be congested and the pulmonary capillary membranes thickened, limiting O₂ diffusion from lung to blood.
  
• The control of breathing is sometimes altered.
  
• The normal rise in cardiac output is both blunted and delayed.
  
• Blood flow to the active muscle is limited, and a CHF-associated muscle wasting can occur.
  
• Alterations take place in the capillary/skeletal muscle interface that limit O₂ diffusion from blood to muscle.
  
• Muscle metabolism can be dysfunctional and oxidative capacity can be limited, which leads to acidosis.
  

See p 3049

A key question, then, is are these maladaptations related or are they merely a summation of physiological "bad luck" associated with poor cardiac function and the resultant physical inactivity? Over the past 20 years one revolutionary idea has been that "overactivation" of the sympathetic nervous system in CHF makes a bad situation worse and broadly contributes to a downward spiral in many elements of the oxygen transport system.^6,7 In addition, during exercise, an inappropriately robust sympathetic response further limits exercise tolerance by evoking larger (and faster) than normal increases in peripheral sympathetic activation from an already increased baseline.⁸ This excessive sympathetic response may have many unfortunate consequences, but one especially negative consequence may be the further sympathetic restraint of blood flow to the active skeletal muscles and even more skeletal muscle hypoperfusion. Together with the structural . . . [Full Text of this Article]

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