Ebook Heart failure management the neural pathways: Part 2
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Ebook Heart failure management the neural pathways: Part 2
Part IIIModulation of Autonomic Function in Heart FailureThe Autonomic Cardiorenal Crosstalk: Pathophysiology and Implications for Heart Failure Manag Ebook Heart failure management the neural pathways: Part 2gement10Maria Rosa Costanzo and Edoardo Gronda10.1IntroductionThe autonomic nervous system (ANS), which comprises the sympathetic and parasympathetic branches, has numerous essential physiologic functions, including modulation of blood pressure, heart rate, and body fluid volume [1]. It is now recog Ebook Heart failure management the neural pathways: Part 2nized that the ANS is organized to elicit organ-specific responses to maintain homeostasis in the face of external challenges (2J.An example of the diEbook Heart failure management the neural pathways: Part 2
fferential organ effects of the ANS is the coordinated response to increase sodium concentration aimed at restoring normal plasma sodium concentrationPart IIIModulation of Autonomic Function in Heart FailureThe Autonomic Cardiorenal Crosstalk: Pathophysiology and Implications for Heart Failure Manag Ebook Heart failure management the neural pathways: Part 2n the settings of hypertension, heart failure (HF), and the cardiorenal syndrome (CRS) (Fig. 10.1). Experiments in conscious sheep have shown that increases in brain sodium concentration simultaneously augment cardiac sympathetic nerve activity (SNA) and arterial pressure and reduce renal SNA. promo Ebook Heart failure management the neural pathways: Part 2ting reduced renin secretion. renal vasodilatation, and renal sodium excretion [l|. Thus, inhibition of renal SNA is the logical homeostatic responseEbook Heart failure management the neural pathways: Part 2
to a sodium load, aimed at restoring normal plasma volume and sodium concentration. These organ-specific effects are mediated via a neural pathway thaPart IIIModulation of Autonomic Function in Heart FailureThe Autonomic Cardiorenal Crosstalk: Pathophysiology and Implications for Heart Failure Manag Ebook Heart failure management the neural pathways: Part 2tions, in experimental animal models of HF induced by rapid pacing, theM R. Costanzo. MD. FACC. FAHA (S)Medical Director. Midwest Heart Specialists-Advocate Medical Group Heart Failure and Pulmonary Arterial Hypertension Programs. Medical Director. Edward Hospital Center for Advanced Heart Failure E Ebook Heart failure management the neural pathways: Part 2dward Heart Hospital. Naperville. Illinois 60566. USAe-mail: Mariarosa.costanzo@advocatehealth.comE. Gronda. MDCardiology and Heart Failure Research UEbook Heart failure management the neural pathways: Part 2
nit. IRCCS MultiMedica - Sesto San Giovanni.Milan. Italye-mail: edoardo.gronda @ mu 11 i med ica. i t© Springer International Publishing Switzerland 2Part IIIModulation of Autonomic Function in Heart FailureThe Autonomic Cardiorenal Crosstalk: Pathophysiology and Implications for Heart Failure Manag Ebook Heart failure management the neural pathways: Part 2aroreceptors of the cartoKl arteryBaroreceptors in aorta \Parasympathetic nerve fibresnode'Cerdioregulatory centre and chemoreceptors in medulla obtongata> Sympathetic nerve fibresParavertebral ganglionFig. 10.1 Organization of the autonomic nervous system demonstrating the key interactions involvin Ebook Heart failure management the neural pathways: Part 2g the brain, heart, and kidney. SA sino-atrial node (Reproduced with permission from Singh et al. 1159])cardiac and renal SNA activities increased toEbook Heart failure management the neural pathways: Part 2
similar, almost maximal levels and the response of cardiac SNA to changes in blood volume was significantly attenuated (1. 5]. These data confirm manyPart IIIModulation of Autonomic Function in Heart FailureThe Autonomic Cardiorenal Crosstalk: Pathophysiology and Implications for Heart Failure Manag Ebook Heart failure management the neural pathways: Part 2response to the increased volume and cardiac pressures, contributes to the heightened sympathetic activity typical of HF [1]. Excessive sympathetic drive is undoubtedly a major contributing factor to the pathogenesis of hypertension and to the progression of HF. Importantly, much of the excessive SN Ebook Heart failure management the neural pathways: Part 2A in these conditions targets the kidney, where it leads to inappropriate sodium retention and renin stimulation and diminished renal function. In addEbook Heart failure management the neural pathways: Part 2
ition, the kidney itself is a source of increased SNA by way of the renal somatic afferent nerves. Therefore, in both hypertension and HF. the kidney Part IIIModulation of Autonomic Function in Heart FailureThe Autonomic Cardiorenal Crosstalk: Pathophysiology and Implications for Heart Failure Manag Ebook Heart failure management the neural pathways: Part 2ing of the bidirectional autonomic interactions between the heart and the kidney is the ability to quantify individual regional SNA activity. For this purpose, sympathetic nerve recording techniques and radiotracer-derived measurements of norepinephrine (NE) spillover into the plasma from individual Ebook Heart failure management the neural pathways: Part 2 organs have been used. The limitations of each technique have led10 The Autonomic Cardiorenal Crosstalk133to the recommendation that they be used togEbook Heart failure management the neural pathways: Part 2
ether [7J. Microneurography provides instantaneous multiunit or single-fiber recordings of electrical transmission in sympathetic nerves, but assessmePart IIIModulation of Autonomic Function in Heart FailureThe Autonomic Cardiorenal Crosstalk: Pathophysiology and Implications for Heart Failure Manag Ebook Heart failure management the neural pathways: Part 2rnal organs where microneurography is not feasible [10-121. During infusion of titrated NE al a constant rate, output of endogenous NE from a given organ (N1Ì “spillover”) can be measured by isotope dilution according to the formula: Ebook Heart failure management the neural pathways: Part 2Part IIIModulation of Autonomic Function in Heart FailureThe Autonomic Cardiorenal Crosstalk: Pathophysiology and Implications for Heart Failure ManagGọi ngay
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