(Circulation. 1995;91:559-561.)
© 1995 American Heart Association, Inc.
Articles |
Exercise Intolerance in Heart Failure
Importance of Skeletal Muscle
From the Cardiology Division, Vanderbilt University Medical Center, Nashville, Tenn.
Correspondence to John R. Wilson, MD, Cardiology Division, RM CC-2218 MCN, Vanderbilt University Medical Center, Nashville, TN 37232-2170.
Key Words: Editorials • heart failure • muscles • exercise • respiration
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Introduction |
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For over a century, investigators have sought to define the mechanisms responsible for exercise intolerance in heart failure. At the outset, this mission appeared a simple one. Exertional dyspnea was attributed to exercise-induced increases in pulmonary wedge pressure. Exertional fatigue was attributed to an inadequate cardiac output. Over the past decade, however, it has become clear that the link between cardiac dysfunction and exertional symptoms in heart failure is far more complex. This understanding has led investigators to explore novel treatment options in heart failure. In this issue of Circulation, Mancini and coworkers describe one such new treatment option: selective respiratory muscle training.
At first glance, respiratory muscle training would appear of little
value since it targets the skeletal muscle rather than the circulatory
system. However, recent observations increasingly suggest that
abnormalities of the skeletal muscle system are important contributors
to exertional symptoms in patients with heart failure. Indeed, there is
growing evidence that the sensations of exertional fatigue and dyspnea
are linked, in part, via the skeletal muscle system. The first evidence that
noncirculatory factors contribute to
exertional symptoms in heart failure came from observations that
acutely altering hemodynamic parameters did not alter exertional
symptoms. The traditional presumption that dyspnea is caused by
elevated intrapulmonary pressures was tested by measuring symptomatic
and ventilatory responses to exercise before and after pharmacologic
manipulation of the pulmonary wedge pressure; excessive ventilatory
levels during exercise have been viewed as a hallmark of lung
dysfunction during exercise. Acute reductions in the pulmonary wedge
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