RT Journal Article SR Electronic T1 Origin of symptoms in chronic heart failure JF Heart JO Heart FD BMJ Publishing Group Ltd and British Cardiovascular Society SP 12 OP 16 DO 10.1136/hrt.2005.066886 VO 92 IS 1 A1 A L Clark YR 2006 UL http://heart.bmj.com/content/92/1/12.abstract AB Skeletal muscle abnormalities are highly prevalent in chronic heart failure and are associated with an increase in the ergoreflex, a muscle reflex stimulated by work done. Stimulation of the ergoreflex results in increased ventilation and contributes to the increased sympathetic activation of the heart failure syndrome. The origin of the skeletal myopathy is related to a chronic imbalance between catabolic and anabolic processes, presumably as a consequence of chronic haemodynamic stress. Symptoms arise from the skeletal myopathy, causing the sensation of fatigue and contributing to the sensation of breathlessness as the myopathy affects respiratory muscle. Ergoreflex activation causes a greater ventilatory response to exercise than normal, contributing to the sensation of breathlessness.