tailieunhanh - Ebook Heart failure management the neural pathways: Part 2

(BQ) Part 2 book "Heart failure management the neural pathways" presents the following contents: The autonomic cardiorenal crosstalk - pathophysiology and implications for heart failure management, barorefl ex activation therapy in heart failure, renal refl exes and denervation in heart failure, back to the future,. | Part III Modulation of Autonomic Function in Heart Failure The Autonomic Cardiorenal Crosstalk Pathophysiology and Implications 10 for Heart Failure Management Maria Rosa Costanzo and Edoardo Gronda Introduction The 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 recognized that the ANS is organized to elicit organ-specific responses to maintain homeostasis in the face of external challenges 2 . An example of the differential organ effects of the ANS is the coordinated response to increase sodium concentration aimed at restoring normal plasma sodium concentration and volume. This process is especially relevant to the normal interactions between heart and kidney and to the understanding of their dysregulation in the settings of hypertension heart failure HF and the cardiorenal syndrome CRS Fig. . 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 promoting reduced renin secretion renal vasodilatation and renal sodium excretion 1 . Thus inhibition of renal SNA is the logical homeostatic response to a sodium load aimed at restoring normal plasma volume and sodium concentration. These organ-specific effects are mediated via a neural pathway that includes an angiotensinergic synapse the lamina termina-lis and the paraventricular nucleus of the hypothalamus 3 4 . In contrast to normal conditions in experimental animal models of HF induced by rapid pacing the . Costanzo MD FACC FAHA Medical Director Midwest Heart Specialists-Advocate Medical Group Heart Failure and Pulmonary Arterial Hypertension Programs Medical Director Edward Hospital Center for Advanced Heart Failure Edward Heart Hospital Naperville Illinois 60566 USA e-mail .