Mark A. Creager

ACCF/AHA/ACR/SCAI/SIR/SVM/SVN/SVS 2010 performance measures for adults with peripheral artery disease. A Report of the American College of Cardiology Foundation/American Heart Association Task Force on Performance Measures, the American College of Radiology, the Society for Cardiac Angiography and Interventions, the Society for Interventional Radiology, the Society for Vascular Medicine, the Socie

A Report of the American College of Cardiology Foundation/American Heart Association Task Force on Performance Measures, the American College of Radiology, the Society for Cardiac Angiography and Interventions, the Society for Interventional Radiology, the Society for Vascular Medicine, the Society for Vascular Nursing, and the Society for Vascular Surgery (Writing Committee to Develop Clinical Performance Measures for Peripheral Artery Disease)*,y

The Peripheral Circulation in Heart Failure

The development and progression of myocardial failure are heralded by the activation of circulating neurohormonal systems that modulate both vascular tone and renal retention of salt and water. In addition, the peripheral Circulation undergoes local changes in response to heart failure that are fundamental to the pathophysiology of this disease state. The fractional distribution of blood flow to the kidneys, limbs, and splanchnic beds decreases, whereas blood flow to the heart and brain is preserved.1,2 The diminished exercise capacity of limb muscles in patients with heart failure may be due, in part, to chronically diminished nutritive perfusion.3,4 Renal hypoperfusion and altered intrarenal hemodynamics may contribute to sodium and water retention.5,6 Previous chapters have focused on the mechanisms underlying systemic activation of the sympathetic nervous system, the renin-angiotensin system, as well as other circulatory neurohormones, such as arginine vasopressin and atrial natriuretic factor.