Factors contributing to the exercise limitation of heart failure

Exertional intolerance is a major clinical problem in ambulatory patients with chronic heart failure and is associated with both muscle fatigue and dyspnea. The increased muscle fatigability is most likely caused by a combination of muscle underperfusion and muscle deconditioning; patients frequentl...

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Bibliographic Details
Published inJournal of the American College of Cardiology Vol. 22; no. 4; pp. A93 - A98
Main Authors Wilson, John R., Mancini, Donna M.
Format Journal Article Conference Proceeding
LanguageEnglish
Published New York, NY Elsevier Inc 01.10.1993
Elsevier Science
Subjects
Biological and medical sciences
Biopsy
Cardiology. Vascular system
Dyspnea - etiology
Dyspnea - physiopathology
Exercise Tolerance - physiology
Fatigue - etiology
Fatigue - physiopathology
Heart
Heart Failure - etiology
Heart Failure - physiopathology
Heart failure, cardiogenic pulmonary edema, cardiac enlargement
Humans
Medical sciences
Muscles - physiopathology
Respiration - physiology
Physical exercise
Human
Heart failure
Chronic
Pathophysiology
Heart disease
Cardiovascular disease
Fatigue
Striated muscle
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Summary:Exertional intolerance is a major clinical problem in ambulatory patients with chronic heart failure and is associated with both muscle fatigue and dyspnea. The increased muscle fatigability is most likely caused by a combination of muscle underperfusion and muscle deconditioning; patients frequently exhibit skeletal muscle atrophy, altered muscle metabolism and reduced mitochondrialbased enzyme levels, consistent with deconditioning. The muscle underperfusion is largely due to impaired arteriolar vasodilation within exercising muscle. Exertional dyspnea appears to be due to increased respiratory muscle work mediated by excessive ventilation and decreased lung compliance. Both excessive carbon dioxide production, secondary to increased muscle lactate release, and increased lung dead space contribute to the excessive ventilation. Decreased lung compliance is caused by chronic pulmonary congestion and fibrosis. Optimal management of exercise intolerance in patients with heart failure requires an understanding of the role of these multiple potential contributors to exertional fatigue and dyspnea.
Bibliography:ObjectType-Article-2
SourceType-Scholarly Journals-1
ObjectType-Feature-1
ObjectType-Review-3
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ISSN:0735-1097
DOI:10.1016/0735-1097(93)90469-H