Interazione tra controllo del respiro, funzione autonomica e pattern respiratorio nello scompenso cardiaco. Nuove possibilitá di intervento riabilitativo

Some of the most invalidating symptoms in subjects with chronic heart failure, such as dyspnea and poor exercise tolerance, correlate poorly with indices of myocardial pump function, but are more related to alterations in autonomic nervous system, respiratory system, in addition to physical deconditioning. Increasing evidence suggests that in addition to pump function abnormalities, sympathetic and parasympathetic abnormalities, increased function of baro-, chemo- and ergoreflex control mechanisms play a pivotal role in the origin of symptoms in these patients, potentiating the mechanisms leading to physical deconditioning and further worsening of symptoms. This underlines the practical importance of studies focused on the possibility of modifying these control mechanisms. Recent evidence indicates that non-pharmacological interventions, such as general physical training, or, particularly, specific types of training of the respiratory pattern, may modify some of these reflex control mechanisms, including the chemoreflex response, and provide potential favorable effects in chronic heart failure.