Document Detail

Hormones in heart failure--regulation and counterregulation.
MedLine Citation:
PMID:  1833197     Owner:  NLM     Status:  MEDLINE    
In chronic heart failure, neurohumoral mechanisms play an important role in the regulation of cardiac performance directly, by influencing systolic and diastolic function of the myocardium, and indirectly, by modulating pre- and afterload. The important vasoconstrictor, fluid and sodium retaining factors are the renin-angiotensin-aldosterone system, sympathetic nerve activity and vasopressin; the vasodilator, volume and sodium eliminating factors are atrial natriuretic peptide, vasodilator prostaglandins, such as prostacyclin and prostaglandin E2, dopamine, bradykinin and, possibly, endothelium-derived relaxing factor and vasoactive intestinal peptide. There is evidence from experimental and clinical studies that sympathetic nerve activity is stimulated in the early phase of the disease, as is the secretion of atrial natriuretic peptide, which increases in proportion to an increased preload. In early or mild heart failure, atrial natriuretic peptide suppresses the activity of the renin-angiotensin-aldosterone system, may prevent an increase in peripheral vascular resistance and preserves renal blood flow. In more severe heart failure, the renin-angiotensin-aldosterone system is activated, leading to an increase of peripheral and renal vascular resistance and fluid and sodium retention. This is associated with an increased production of vasodilator prostaglandins. In severe heart failure, mostly in connection with hyponatraemia, a non-osmolar inappropriately high secretion of vasopressin can be demonstrated. These findings suggest that early therapeutic intervention to suppress unfavourable neurohumoral mechanisms or to support protective factors, such as atrial natriuretic peptide, may be of particular importance in the treatment of congestive heart failure, delaying progression of the disease, which would improve survival.
A J Riegger
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Publication Detail:
Type:  Journal Article; Research Support, Non-U.S. Gov't    
Journal Detail:
Title:  European heart journal     Volume:  12 Suppl D     ISSN:  0195-668X     ISO Abbreviation:  Eur. Heart J.     Publication Date:  1991 Aug 
Date Detail:
Created Date:  1991-11-08     Completed Date:  1991-11-08     Revised Date:  2007-11-15    
Medline Journal Info:
Nlm Unique ID:  8006263     Medline TA:  Eur Heart J     Country:  ENGLAND    
Other Details:
Languages:  eng     Pagination:  190-2     Citation Subset:  IM    
Medizinische Universitätsklinik, Würzburg, FRG.
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MeSH Terms
Atrial Natriuretic Factor / physiology*
Heart Failure / physiopathology*
Prostaglandins / physiology*
Renal Circulation / physiology
Renin-Angiotensin System / physiology*
Sympathetic Nervous System / physiology
Vasopressins / physiology*
Reg. No./Substance:
0/Prostaglandins; 11000-17-2/Vasopressins; 85637-73-6/Atrial Natriuretic Factor

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