Vagal afferents, sympathetic efferents and the role of the PVN in heart failure.

Sympatho-excitation is a characteristic of cardiovascular disease including heart failure (HF). The paraventricular nucleus of the hypothalamus (PVN) is an important site for central integration of sympathetic outflow. Atrial volume receptors (AVRs) in the wall of the right atrium transduce cardiovascular variables (pressure/volume) into an input that is integrated centrally, in for example, the PVN. Descriptions of the location and structure of the AVRs as well as the molecular mechanism initiating transduction remain scarce, nevertheless preautonomic neurons of the PVN have been consistently identified as making a significant contribution to the sympatho-excitation evident in HF. Furthermore, excitatory and inhibitory interactions within the PVN determine sympathetic tone. A nitric oxide dependent GABAergic inhibition sets the prevailing sympathetic output from the PVN, which in HF becomes dysregulated. Inflammation and oxidative stress have been recognised as possible triggers to the disinhibition. The actions of proinflammatory cytokines and reactive oxygen species in relation to the signalling pathways, which are important in generating sympathetic tone are discussed, as well as the contribution these might make to abnormal control of the sympathetic nervous system in cardiovascular disease.