Skeletal muscle abnormalities and evidence for their role in symptom generation in chronic heart failure.

The syndrome of chronic heart failure is characterized by exercise limitation usually associated with breathlessness or fatigue. The mechanism by which this exercise intolerance is generated remains unclear. Although muscular atrophy has been recognised as a part of the chronic heart failure syndrome for many years'" only recently has skeletal muscle been studied in any detail. Widespread abnormalities have been discovered and it has been proposed that these muscle abnormalities may contribute to the symptoms suffered by patients"'. This review will consider what is known of these muscle abnormalities, how they may be generated and the evidence that they may limit exercise capacity in chronic heart failure.