Background-The overactivity of ergoreceptors (intramuscular afferents sensitive to products of skeletal muscle work) may be responsible for the abnormal responses to exercise and symptoms of exercise intolerance in chronic heart failure (CHF); however, little is known of the chemical nature of the stimuli involved. We investigated biochemical factors (H ϩ , V CO 2 , V O 2 , HCO 3 , K ϩ , phosphate, lactate, PGE 2 , PGF 1␣ , and bradykinin) potentially involved in ergoreceptor activation. Methods and Results-Sixteen stable patients with CHF (64.9Ϯ2.7 years, peak V O 2 15.8Ϯ0.7 mL/kg per min) and 10 age-matched controls were studied. The ergoreceptor test involved two 5-minute handgrip exercises. On one occasion, the subjects recovered normally (control recovery), whereas on the other a posthandgrip regional circulatory occlusion was induced in the exercising arm, isolating the stimulation of the ergoreceptor after exercise. The ergoreflex was quantified as the difference in ventilation between the posthandgrip regional circulatory occlusion and the control recovery periods. During the protocol, the local muscular blood effluent concentrations of metabolic mediators were assessed. Patients had an ergoreflex effect on ventilation greater than controls (4.8Ϯ1. Key Words: exercise Ⅲ muscles Ⅲ ventilation C hronic heart failure (CHF) is a common cardiovascular condition with both a high mortality and a high burden of morbidity. Muscle fatigue and breathlessness are major symptoms and relate to a poor prognosis; objectively, patients show reduced exercise tolerance and an increased ventilatory response to exercise, the mechanisms of which are still not completely understood. 1 An overactivation of the muscle ergoreceptor response during exercise is closely related to patient symptoms and to the ventilatory response to exercise; a putative role of this reflex in exercise intolerance in CHF has been hypothesized. 2 In particular, the muscle ergoreflexes of the forearm muscles, 2 the small muscles used in dorsiflexing the foot, 3 and the muscles of the quadriceps 4 cause an enhanced ventilatory response in this syndrome. However, the pathophysiology of such an overactivation in CHF has not yet been investigated.The ergoreflex consists of a brain-stem autonomic and ventilatory response activated by signals from the periphery, such as free nerve-ending group III and IV muscle afferents. 5 It has been hypothesized that muscle metabolic abnormalities or circulatory insufficiency of CHF might cause local overproduction and accumulation of muscle metabolic products, which activate these afferents. 6 This is in accordance with the observation of a decreased muscular metabolic capacity, attributable to structural and functional changes within the muscles, such as changes in fiber type and decreased activity of oxidative enzymes in patients with CHF. 7 The triggering factors responsible for the ergoreflex stimulation and their involvement in the abnormal exercise responses in CHF are yet to be established. We therefore set out a n...