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Congestive heart failure is a complex clinical syndrome characterized by striking abnormalities of the autonomic nervous system. The mechanisms and biological importance of these disturbances are not clearly defined. Nonetheless, it is possible that autonomic disturbances play an important role in the pathophysiology and prognosis of heart failure, and therefore drugs that alter autonomic function may provide additional therapeutic options in the management of this syndrome. INTRODUCTION Whereas deaths from coronary disease and stroke are rapidly declining, congestive heart failure is a problem of growing magnitude in the United States (1). It is estimated that each year 200,000 people die from heart failure in this country (2). Most physicians have a well-conceived concept of just what congestive heart failure is, yet the complexities of the syndrome do not allow it to be easily defined. There is no single laboratory index that measures or defines heart failure. Heart failure is characterized by a series of compensatory responses designed to maintain perfusion pressure (3) and redistribute flow (4). We do not understand the signal that is principally responsible for activating these responses, but it is likely that some integration of pressure, flow, and blood volume is involved. The sites where
Annual Review of Medicine – Annual Reviews
Published: Feb 1, 1986
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