Cardiology in review
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Cardiology in review · Nov 2010
ReviewRelaxin: a new approach for the treatment of acute congestive heart failure.
Relaxin, a naturally-occurring hormone in the insulin family, was discovered to have a physiologic role in pregnancy. Named initially for its relaxing effect on the pubic ligament, relaxin receptors have since been found to be widely distributed in many organs in both males and females. ⋯ Due to these effects, relaxin has been examined as a treatment for acute heart failure. The results of phase I and II trials have shown favorable clinical trends without any major adverse events, suggesting that relaxin has the potential to be an effective medication for acute heart failure in conjunction with or in place of current treatments.
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Cardiology in review · Nov 2010
ReviewThe pleiotropic effects of the hydroxy-methyl-glutaryl-CoA reductase inhibitors in cardiovascular disease: a comprehensive review.
The hydroxy-methyl-glutaryl-CoA reductase inhibitors (statins) are used extensively in the treatment of hyperlipidemia, and in the long-term prevention of coronary artery disease and stroke. They have also demonstrated a benefit in a variety of other cardiovascular disease processes. These secondary actions are known as pleiotropic effects. An updated discussion on the pleiotropy of statins is provided, and emphasizes the importance of randomized, placebo-controlled trials to further elucidate the potential benefits of these non-lipid-lowering actions in the treatment of cardiovascular disease.
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Cardiology in review · Jul 2010
Review Historical ArticleNitrates and nitrites in the treatment of ischemic cardiac disease.
The organic nitrite, amyl of nitrite, was initially used as a therapeutic agent in the treatment of angina pectoris, but was replaced over a decade later by the organic nitrate, nitroglycerin (NTG), due to the ease of administration and longer duration of action. The administration of organic nitrate esters, such as NTG, continues to be used in the treatment of angina pectoris and heart failure since the birth of modern pharmacology. Their clinical effectiveness is due to vasodilator activity in large veins and arteries through an as yet unidentified method of delivering nitric oxide (NO), or a NO-like compound. ⋯ Although the actions of these 2 similar chemical classes (nitrites and organic nitrates) have often been considered to be alike, we still do not understand their mechanism of action. Finally, the nitrite anion, either from sodium nitrite or an intermediate NTG form, may act as a storage form for NO and provide support for investigating the use of these agents in the treatment of ischemic cardiovascular states. We review what is presently known about the use of nitrates and nitrites including the historical, current, and potential uses of these agents, and their mechanisms of action.
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Mitral regurgitation after a myocardial infarction is common. It can occur acutely or chronically, and its presence portends a poor prognosis. The focus of this article will be on chronic ischemic mitral regurgitation. We will discuss the current concepts of its pathophysiology, the benefits of revascularization, along with the surgical, and percutaneous therapeutic options.
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Cardiology in review · Mar 2010
ReviewManagement of pulmonary arterial hypertension in the neonatal unit.
This review article discusses the pathophysiology and management of pulmonary hypertension (PH) in the newborn unit. The discussion revolves around 2 aspects: persistent pulmonary hypertension in the newborn, which is seen in the first few weeks of life, and PH associated with chronic lung disease in the post neonatal period of infancy. Although the etiopathogenesis as well as prognosis for infantile PH differ from older children and adults, the basic principles of management are similar. Inhaled nitric oxide, intravenous prostacyclin and its analogs, and oral medications like sildenafil and endothelin receptor blockers play a very important role in PH management in the newborn unit, in addition to ventilation strategies and acid-based balance management.