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Changes in the neuroendocrine system in heart failure

Last reviewed dd mmm yyyy. Last edited dd mmm yyyy

Authoring team

The neuroendocrine systems which are most profoundly affected by heart failure are:

Renin-aldosterone system:

  • the renin-aldosterone system is inactive or only slightly activated in untreated heart failure
  • diuretics greatly stimulate renin production
  • angiotensin II increases peripheral vascoconstriction and hence the afterload on the heart
  • angiotensin II causes constriction of the efferent arteriole in the kidney:
    • in the normal kidney this may maintain the glomerular filtration rate in the face of reduced arterial blood pressure
    • in a kidney which is already dependent on angiotensin II e.g. in renal artery stenosis, further angiotensin II may cause reduced renal function
  • angiotensin II may be directly toxic to myocytes

Autonomic nervous system:

  • the sympathetic system is activated
  • the parasympathic tone is reduced
  • there is no good explanation for these changes
  • increased sympathetic activity may be detected by analysing heart rate variability
  • increased sympathetic activity is associated with fatal arrhythmias

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