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Possible mechanisms by which overloading can cause progressive deterioration of the heart (cardiomyopathy of overload). Several mechanisms, including
myocyte stretch, activate a growth response that initiates myocardial hypertrophy in the overloaded heart (left). The same growth response can also
activate signal transduction systems that cause programmed cell death (apoptosis). The hypertrophic response to overload, by causing sarcomeres to be
added in series, can also lead to cell elongation and accelerate remodeling; the resulting increase in wall tension, together with the overload itself (right),
increases cardiac energy expenditure that, in the overloaded heart, can accelerate myocyte necrosis. Reduced cardiac output activates neurohumoral
responses (center), which, by increasing afterload and β–adrenergic stimulation of the heart, also increase cardiac energy expenditure. Because many
Source: Chapter 26. Pathophysiology of Heart Failure, Hurst's The Heart, 13e
mediators of the neurohumoral response to a decrease in cardiac output promote myocardial cell growth, neurohumoral activation can also accelerate both
Citation:
Fuster V, Walsh RA, Harrington RA. Hurst's The Heart, 13e; 2011 Available at: http://mhmedical.com/ Accessed: May 12, 2017
apoptosis and
remodeling.
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