The sympathetic nervous system and pathophysiology of congestive heart failure.

Understanding of the initiation and progression of congestive heart failure was previously based on the hemodynamic hypothesis, which held that the primary pathophysiology of myocardial dysfunction was due to impairment of the myocardium's ability to function as a pump. The neurohormonal hypothesis, which supplanted this hypothesis, suggests that activation of the sympathetic nervous system following a decline in myocardial systolic performance is associated with a significant adverse long-term effect on the functioning myocardium irrespective of etiology and hemodynamic stature. This article will discuss of the role of the sympathetic nervous system in congestive heart failure and the use of beta-blockade as a means to improve both hemodynamics and progression of disease.