Skip to main content
PMC home page
Heart logoLink to Heart
. 2001 Nov;86(5):574–578. doi: 10.1136/heart.86.5.574

What causes the symptoms of heart failure?

A Coats 1
PMCID: PMC1729962  PMID: 11602559

Full Text

The Full Text of this article is available as a PDF (136.8 KB).

Figure 1:  .

Figure 1:  

Open in a new tab

Lack of correlation between exercise capacity and resting left ventricular ejection fraction in 239 patients attending the cardiopulmonary exercise laboratory of the Royal Brompton Hospital, London, UK.

Figure 2:  .

Figure 2:  

Open in a new tab

The muscle hypothesis of chronic heart failure, in which it is proposed that alterations in skeletal muscle contribute not only to symptom generation but also, via reflex effects, to further neurohormonal activation and progression of the syndrome of CHF.

Figure 3:  .

Figure 3:  

Open in a new tab

Plot of minute ventilation (VE) versus the rate of carbon dioxide production (VCO2) in three patients with chronic heart failure. You can see that the ventilation needed for the same carbon dioxide elimination rate increases with the increasing severity of heart failure. This is associated with a greater sensation of dyspnoea despite preservation of arterial blood gases in these patients.

Figure 4:  .

Figure 4:  

Open in a new tab

Relation between the minute ventilation to carbon dioxide production slope and exercise capacity in 248 patients with chronic heart failure.

Selected References

These references are in PubMed. This may not be the complete list of references from this article.

  1. Adamopoulos S., Coats A. J., Brunotte F., Arnolda L., Meyer T., Thompson C. H., Dunn J. F., Stratton J., Kemp G. J., Radda G. K. Physical training improves skeletal muscle metabolism in patients with chronic heart failure. J Am Coll Cardiol. 1993 Apr;21(5):1101–1106. doi: 10.1016/0735-1097(93)90231-o. [DOI] [PubMed] [Google Scholar]
  2. Anker S. D., Chua T. P., Ponikowski P., Harrington D., Swan J. W., Kox W. J., Poole-Wilson P. A., Coats A. J. Hormonal changes and catabolic/anabolic imbalance in chronic heart failure and their importance for cardiac cachexia. Circulation. 1997 Jul 15;96(2):526–534. doi: 10.1161/01.cir.96.2.526. [DOI] [PubMed] [Google Scholar]
  3. Anker S. D., Clark A. L., Kemp M., Salsbury C., Teixeira M. M., Hellewell P. G., Coats A. J. Tumor necrosis factor and steroid metabolism in chronic heart failure: possible relation to muscle wasting. J Am Coll Cardiol. 1997 Oct;30(4):997–1001. doi: 10.1016/s0735-1097(97)00262-3. [DOI] [PubMed] [Google Scholar]
  4. Anker S. D., Ponikowski P., Varney S., Chua T. P., Clark A. L., Webb-Peploe K. M., Harrington D., Kox W. J., Poole-Wilson P. A., Coats A. J. Wasting as independent risk factor for mortality in chronic heart failure. Lancet. 1997 Apr 12;349(9058):1050–1053. doi: 10.1016/S0140-6736(96)07015-8. [DOI] [PubMed] [Google Scholar]
  5. Barletta G., Del Bene M. R., Gallini C., Salvi S., Costanzo E., Masini M., Galeota G., Fantini F. The clinical impact of dynamic intraventricular obstruction during dobutamine stress echocardiography. Int J Cardiol. 1999 Jul 31;70(2):179–189. doi: 10.1016/s0167-5273(99)00081-9. [DOI] [PubMed] [Google Scholar]
  6. Bol E., de Vries W. R., Mosterd W. L., Wielenga R. P., Coats A. J. Cardiopulmonary exercise parameters in relation to all-cause mortality in patients with chronic heart failure. Int J Cardiol. 2000 Feb 15;72(3):255–263. doi: 10.1016/s0167-5273(99)00195-3. [DOI] [PubMed] [Google Scholar]
  7. Chua T. P., Clark A. L., Amadi A. A., Coats A. J. Relation between chemosensitivity and the ventilatory response to exercise in chronic heart failure. J Am Coll Cardiol. 1996 Mar 1;27(3):650–657. doi: 10.1016/0735-1097(95)00523-4. [DOI] [PubMed] [Google Scholar]
  8. Chua T. P., Coats A. J. The lungs in chronic heart failure. Eur Heart J. 1995 Jul;16(7):882–887. doi: 10.1093/oxfordjournals.eurheartj.a061019. [DOI] [PubMed] [Google Scholar]
  9. Chua T. P., Ponikowski P. P., Harrington D., Chambers J., Coats A. J. Contribution of peripheral chemoreceptors to ventilation and the effects of their suppression on exercise tolerance in chronic heart failure. Heart. 1996 Dec;76(6):483–489. doi: 10.1136/hrt.76.6.483. [DOI] [PMC free article] [PubMed] [Google Scholar]
  10. Chua T. P., Ponikowski P., Harrington D., Anker S. D., Webb-Peploe K., Clark A. L., Poole-Wilson P. A., Coats A. J. Clinical correlates and prognostic significance of the ventilatory response to exercise in chronic heart failure. J Am Coll Cardiol. 1997 Jun;29(7):1585–1590. doi: 10.1016/s0735-1097(97)00078-8. [DOI] [PubMed] [Google Scholar]
  11. Clark A. L., Poole-Wilson P. A., Coats A. J. Exercise limitation in chronic heart failure: central role of the periphery. J Am Coll Cardiol. 1996 Nov 1;28(5):1092–1102. doi: 10.1016/S0735-1097(96)00323-3. [DOI] [PubMed] [Google Scholar]
  12. Clark A. L., Sparrow J. L., Coats A. J. Muscle fatigue and dyspnoea in chronic heart failure: two sides of the same coin? Eur Heart J. 1995 Jan;16(1):49–52. doi: 10.1093/eurheartj/16.1.49. [DOI] [PubMed] [Google Scholar]
  13. Clausen J. P. Circulatory adjustments to dynamic exercise and effect of physical training in normal subjects and in patients with coronary artery disease. Prog Cardiovasc Dis. 1976 May-Jun;18(6):459–495. doi: 10.1016/0033-0620(76)90012-8. [DOI] [PubMed] [Google Scholar]
  14. Clini E., Volterrani M., Pagani M., Bianchi L., Porta R., Gile' L. S., Giordano A., Ambrosino N. Endogenous nitric oxide in patients with chronic heart failure (CHF): relation to functional impairment and nitrate-containing therapies. Int J Cardiol. 2000 Apr 28;73(2):123–134. doi: 10.1016/s0167-5273(00)00211-4. [DOI] [PubMed] [Google Scholar]
  15. Coats A. J., Adamopoulos S., Meyer T. E., Conway J., Sleight P. Effects of physical training in chronic heart failure. Lancet. 1990 Jan 13;335(8681):63–66. doi: 10.1016/0140-6736(90)90536-e. [DOI] [PubMed] [Google Scholar]
  16. Coats A. J., Adamopoulos S., Radaelli A., McCance A., Meyer T. E., Bernardi L., Solda P. L., Davey P., Ormerod O., Forfar C. Controlled trial of physical training in chronic heart failure. Exercise performance, hemodynamics, ventilation, and autonomic function. Circulation. 1992 Jun;85(6):2119–2131. doi: 10.1161/01.cir.85.6.2119. [DOI] [PubMed] [Google Scholar]
  17. Coats A. J. Inflammation, hormones, the blood and the heart; are cardiologists learning to be internists again? Int J Cardiol. 2000 Feb 15;72(3):203–205. doi: 10.1016/s0167-5273(00)00169-8. [DOI] [PubMed] [Google Scholar]
  18. Drexler H., Banhardt U., Meinertz T., Wollschläger H., Lehmann M., Just H. Contrasting peripheral short-term and long-term effects of converting enzyme inhibition in patients with congestive heart failure. A double-blind, placebo-controlled trial. Circulation. 1989 Mar;79(3):491–502. doi: 10.1161/01.cir.79.3.491. [DOI] [PubMed] [Google Scholar]
  19. Drexler H., Riede U., Münzel T., König H., Funke E., Just H. Alterations of skeletal muscle in chronic heart failure. Circulation. 1992 May;85(5):1751–1759. doi: 10.1161/01.cir.85.5.1751. [DOI] [PubMed] [Google Scholar]
  20. Florea V. G., Mareyev V. Y., Achilov A. A., Popovici M. I., Coats A. J., Belenkov Y. N. Central and peripheral components of chronic heart failure: determinants of exercise tolerance. Int J Cardiol. 1999 Jul 1;70(1):51–56. doi: 10.1016/s0167-5273(99)00047-9. [DOI] [PubMed] [Google Scholar]
  21. Franciosa J. A., Baker B. J., Seth L. Pulmonary versus systemic hemodynamics in determining exercise capacity of patients with chronic left ventricular failure. Am Heart J. 1985 Oct;110(4):807–813. doi: 10.1016/0002-8703(85)90461-2. [DOI] [PubMed] [Google Scholar]
  22. Francis D. P., Shamim W., Davies L. C., Piepoli M. F., Ponikowski P., Anker S. D., Coats A. J. Cardiopulmonary exercise testing for prognosis in chronic heart failure: continuous and independent prognostic value from VE/VCO(2)slope and peak VO(2). Eur Heart J. 2000 Jan;21(2):154–161. doi: 10.1053/euhj.1999.1863. [DOI] [PubMed] [Google Scholar]
  23. Grieve D. A., Clark A. L., McCann G. P., Hillis W. S. The ergoreflex in patients with chronic stable heart failure. Int J Cardiol. 1999 Feb 28;68(2):157–164. doi: 10.1016/s0167-5273(98)00349-0. [DOI] [PubMed] [Google Scholar]
  24. Hambrecht R., Niebauer J., Fiehn E., Kälberer B., Offner B., Hauer K., Riede U., Schlierf G., Kübler W., Schuler G. Physical training in patients with stable chronic heart failure: effects on cardiorespiratory fitness and ultrastructural abnormalities of leg muscles. J Am Coll Cardiol. 1995 May;25(6):1239–1249. doi: 10.1016/0735-1097(94)00568-B. [DOI] [PubMed] [Google Scholar]
  25. Harrington D., Chua T. P., Coats A. J. The effect of salbutamol on skeletal muscle in chronic heart failure. Int J Cardiol. 2000 May 31;73(3):257–265. doi: 10.1016/s0167-5273(00)00233-3. [DOI] [PubMed] [Google Scholar]
  26. Jondeau G., Katz S. D., Zohman L., Goldberger M., McCarthy M., Bourdarias J. P., LeJemtel T. H. Active skeletal muscle mass and cardiopulmonary reserve. Failure to attain peak aerobic capacity during maximal bicycle exercise in patients with severe congestive heart failure. Circulation. 1992 Nov;86(5):1351–1356. doi: 10.1161/01.cir.86.5.1351. [DOI] [PubMed] [Google Scholar]
  27. Juillière Y., Grentzinger A., Houplon P., Démoulin S., Berder V., Suty-Selton C. Role of the etiology of cardiomyopathies on exercise capacity and oxygen consumption in patients with severe congestive heart failure. Int J Cardiol. 2000 May 31;73(3):251–255. doi: 10.1016/s0167-5273(00)00231-x. [DOI] [PubMed] [Google Scholar]
  28. Mancini D. M., Henson D., LaManca J., Levine S. Evidence of reduced respiratory muscle endurance in patients with heart failure. J Am Coll Cardiol. 1994 Oct;24(4):972–981. doi: 10.1016/0735-1097(94)90858-3. [DOI] [PubMed] [Google Scholar]
  29. Massie B. M., Conway M., Rajagopalan B., Yonge R., Frostick S., Ledingham J., Sleight P., Radda G. Skeletal muscle metabolism during exercise under ischemic conditions in congestive heart failure. Evidence for abnormalities unrelated to blood flow. Circulation. 1988 Aug;78(2):320–326. doi: 10.1161/01.cir.78.2.320. [DOI] [PubMed] [Google Scholar]
  30. Morales F. J., Montemayor T., Martinez A. Shuttle versus six-minute walk test in the prediction of outcome in chronic heart failure. Int J Cardiol. 2000 Nov-Dec;76(2-3):101–105. doi: 10.1016/s0167-5273(00)00393-4. [DOI] [PubMed] [Google Scholar]
  31. Niebauer J., Pflaum C. D., Clark A. L., Strasburger C. J., Hooper J., Poole-Wilson P. A., Coats A. J., Anker S. D. Deficient insulin-like growth factor I in chronic heart failure predicts altered body composition, anabolic deficiency, cytokine and neurohormonal activation. J Am Coll Cardiol. 1998 Aug;32(2):393–397. doi: 10.1016/s0735-1097(98)00226-5. [DOI] [PubMed] [Google Scholar]
  32. Piepoli M. F., Capucci A. Exercise training in heart failure: effect on morbidity and mortality. Int J Cardiol. 2000 Mar 31;73(1):3–6. doi: 10.1016/s0167-5273(99)00220-x. [DOI] [PubMed] [Google Scholar]
  33. Piepoli M., Clark A. L., Volterrani M., Adamopoulos S., Sleight P., Coats A. J. Contribution of muscle afferents to the hemodynamic, autonomic, and ventilatory responses to exercise in patients with chronic heart failure: effects of physical training. Circulation. 1996 Mar 1;93(5):940–952. doi: 10.1161/01.cir.93.5.940. [DOI] [PubMed] [Google Scholar]
  34. Ponikowski P., Francis D. P., Piepoli M. F., Davies L. C., Chua T. P., Davos C. H., Florea V., Banasiak W., Poole-Wilson P. A., Coats A. J. Enhanced ventilatory response to exercise in patients with chronic heart failure and preserved exercise tolerance: marker of abnormal cardiorespiratory reflex control and predictor of poor prognosis. Circulation. 2001 Feb 20;103(7):967–972. doi: 10.1161/01.cir.103.7.967. [DOI] [PubMed] [Google Scholar]
  35. Sharma R., Coats A. J., Anker S. D. The role of inflammatory mediators in chronic heart failure: cytokines, nitric oxide, and endothelin-1. Int J Cardiol. 2000 Jan 15;72(2):175–186. doi: 10.1016/s0167-5273(99)00186-2. [DOI] [PubMed] [Google Scholar]
  36. Sullivan M. J., Green H. J., Cobb F. R. Skeletal muscle biochemistry and histology in ambulatory patients with long-term heart failure. Circulation. 1990 Feb;81(2):518–527. doi: 10.1161/01.cir.81.2.518. [DOI] [PubMed] [Google Scholar]
  37. Sullivan M. J., Higginbotham M. B., Cobb F. R. Exercise training in patients with severe left ventricular dysfunction. Hemodynamic and metabolic effects. Circulation. 1988 Sep;78(3):506–515. doi: 10.1161/01.cir.78.3.506. [DOI] [PubMed] [Google Scholar]
  38. Sullivan M. J., Higginbotham M. B., Cobb F. R. Increased exercise ventilation in patients with chronic heart failure: intact ventilatory control despite hemodynamic and pulmonary abnormalities. Circulation. 1988 Mar;77(3):552–559. doi: 10.1161/01.cir.77.3.552. [DOI] [PubMed] [Google Scholar]
  39. Swan J. W., Walton C., Godsland I. F., Clark A. L., Coats A. J., Oliver M. F. Insulin resistance in chronic heart failure. Eur Heart J. 1994 Nov;15(11):1528–1532. doi: 10.1093/oxfordjournals.eurheartj.a060425. [DOI] [PubMed] [Google Scholar]
  40. Tyni-Lenné R., Gordon A., Jansson E., Bermann G., Sylvén C. Skeletal muscle endurance training improves peripheral oxidative capacity, exercise tolerance, and health-related quality of life in women with chronic congestive heart failure secondary to either ischemic cardiomyopathy or idiopathic dilated cardiomyopathy. Am J Cardiol. 1997 Oct 15;80(8):1025–1029. doi: 10.1016/s0002-9149(97)00597-3. [DOI] [PubMed] [Google Scholar]
  41. Vescovo G., Serafini F., Facchin L., Tenderini P., Carraro U., Dalla Libera L., Catani C., Ambrosio G. B. Specific changes in skeletal muscle myosin heavy chain composition in cardiac failure: differences compared with disuse atrophy as assessed on microbiopsies by high resolution electrophoresis. Heart. 1996 Oct;76(4):337–343. doi: 10.1136/hrt.76.4.337. [DOI] [PMC free article] [PubMed] [Google Scholar]
  42. Volterrani M., Clark A. L., Ludman P. F., Swan J. W., Adamopoulos S., Piepoli M., Coats A. J. Predictors of exercise capacity in chronic heart failure. Eur Heart J. 1994 Jun;15(6):801–809. doi: 10.1093/oxfordjournals.eurheartj.a060588. [DOI] [PubMed] [Google Scholar]
  43. Wielenga R. P., Erdman R. A., Huisveld I. A., Bol E., Dunselman P. H., Baselier M. R., Mosterd W. L. Effect of exercise training on quality of life in patients with chronic heart failure. J Psychosom Res. 1998 Nov;45(5):459–464. doi: 10.1016/s0022-3999(97)00309-7. [DOI] [PubMed] [Google Scholar]
  44. Zelis R., Nellis S. H., Longhurst J., Lee G., Mason D. T. Abnormalities in the regional circulations accompanying congestive heart failure. Prog Cardiovasc Dis. 1975 Nov-Dec;18(3):181–199. doi: 10.1016/0033-0620(75)90010-9. [DOI] [PubMed] [Google Scholar]

Articles from Heart are provided here courtesy of BMJ Publishing Group

RESOURCES