Survey of the attitudes of British physicians to pacing.

Neurohormonal dysfunction is an important and potentially modifiable part of the disease process of heart failure. In this review we will discuss the ways in which the autonomic system is deranged in congestive cardiac failure and the different ways we have of monitoring these abnormalities i.e.: heart rate variability, plasma norephinephrine activity, MIBG scanning, heart rate turbulence, baroreceptor function and briefly, microneurographic techniques and QT interval analysis. We will then discuss the direct effects of aldosterone and of aldosterone blockade on some of these parameters. We conclude that neurohormonal dysfunction is an important component of chronic heart failure, which is affected by aldosterone and can be modified by the use of aldosterone receptor blockade.

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Autonomic Effects of Spironolactone and MR Blockers in Heart Failure

Davies

Witham

Struthers

2005

Heart Fail Rev

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Aldosterone blockade reduces vascular collagen turnover, improves heart rate variability and reduces early morning rise in heart rate in heart failure patients

MacFadyen

Barr

Struthers

1997

Cardiovascular Research

298

164

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These are the first human data to show that use of the aldosterone antagonist, spironolactone, can positively improve time-domain heart rate variability and reduce myocardial collagen turnover, as reflected by further reductions in serum procollagen peptide, despite concurrent ACE inhibitor treatment. Residual aldosterone after ACE inhibitor treatment may therefore have a role promoting arrhythmia and cardiac death by two mechanisms. Effects of additional spironolactone on slowing heart rate (and potentially the detrimental effect of aldosterone) were most prominent between 6 a.m. and 10 a.m. when cardiac death is also known to be most prominent.

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Permanent pacemaker practice at a Scottish district general hospital between 1987 and 1993.

Doherty

Dawson

Kerr

1995

Heart

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Survey of the attitudes of British physicians to pacing.

Cited by 5 publications

References 10 publications

Autonomic Effects of Spironolactone and MR Blockers in Heart Failure

Autonomic Effects of Spironolactone and MR Blockers in Heart Failure

Aldosterone blockade reduces vascular collagen turnover, improves heart rate variability and reduces early morning rise in heart rate in heart failure patients

Permanent pacemaker practice at a Scottish district general hospital between 1987 and 1993.

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