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BITS Pilani
Pilani Campus
BITS Pilani
Pilani Campus
Outline
Introduction Epidemiology What is CCF - Pathophysiology Symptoms Recent advances in CCF Newer drugs used in CCF Conclusion References
BITS Pilani, Pilani Campus
Introduction
In simple terms, CHF/CCF is a condition where in the heart is unable to pump sufficient blood to meet the needs of the body. Chronic CHF may be defined as the clinical condition in which an individual expels less than 40% of the blood from the left ventricle per heartbeat (ejection fraction [EF] 40%).A normal individual expels about 55 to 65% of the blood from the left ventricle per heartbeat (EF 5565%).
Epidemiology
5 Million Americans have Heart failure 500,000 new cases per year 25-50 billion USD per year spent on treating CHF More than 300,000 deaths per year Women relatively run a lower risk of CHF than men
Causes of CHF
Aging Hypertension Chronic alcoholism History of Myocardial infarction Diabetes Myocarditis Cardiomyopathy Coronary artery disease
Types of CHF
Right sided heart failure: A improper pumping action of the right ventricle which leads to swelling in the legs and abdomen Left sided heart failure: The failure of the left ventricular pumping leading to congestion in the lungs
Pathophysiology
Ang-(1-7) also exerts antiproliferative actions that could be of interest in several cardiovascular diseases including heart failure and atherosclerosis. The potential therapeutic benefit of Ang-(1-7) is also supported by the fact that endogenous Ang-(1-7) levels or the effect of the heptapeptide are modified in pathological conditions. Ang-(1-7) also seems to play a protective role during acute myocardial infarction, considering that chronic infusion of the heptapeptide reduces arrhythmias [48] and attenuates development of heart failure after myocardial infarction in rats
BITS Pilani, Pilani Campus
Sildenafil
Reference:
PDE-5 Inhibitor
Vasopeptidase Inhibitor
Dual acting compounds that augment the activity of natriuretic peptides while inhibiting RAAS activity may offer benefits for the treatment of cardiovascular disease Eg. Gemopatrilat Samipatrilat Fasidotril Mixanpril Z-13752 A MDL-100240
Angiotensin II
Statins
- Reactive Oxygen Species (ROS) contribute to the development of heart failure. - Potential source of myocaridial ROS is the NADPH oxidase, which is regulated by the small GTP- binding protein Rac 1. - Statins are useful in reducing the Rac1- GTPase activity. - Eg. Atorvastatin Pravastatin
Statins: MOA
Vasopeptidase inhibitors L-arginine and L-carnitine ACE-1 inhibitors Endothelin 1 receptor Cardiac resynchronization therapy in heart failure
Vasopeptidase inhibitors
Vasopeptidase inhibitors represent a new class of cardiovascular drugs. They function as a combined angiotensin-converting enzyme (ACE) inhibitor and neutral endopeptidase (NEP) inhibitor, the latter of which potentiates the actions of atrial natriuretic peptide (ANP) by minimizing its degradation in the circulation.
Vasopeptidase inhibitors have also shown to potentiate bradykinin and adrenomedullin, which additionally contribute to cardiovascular regulation. The most extensively researched and promising agents within the class of VP inhibitors is omapatrilat, a mercaptoacyl derivative of a bicyclic thiazepinone dipeptide. It is a single molecule with equal potency and affinity for ACE and NEP inhibition. Although ACE inhibition tends to more selectively benefit high-renin models of hypertension, vasopeptidase inhibition has been shown to be equally efficacious in low-, normal-, and high-renin models.
BITS Pilani, Pilani Campus
Contrary to NEP inhibition alone, omapatrilat has also demonstrated the ability to significantly reduce blood pressure in spontaneously hypertensive rats, the equivalent of essential hypertension in humans. Studies also suggest that omapatrilat has cardioprotective properties, especially in the setting of congestive heart failure. More specifically, animal models have demonstrated omapatrilat to be more effective than ACE inhibition alone in remodeling the heart and improving its contractile function.
Ace-1 inhibitors
Ace-1 inhibitors
Endothelin 1 receptor(ET-1)
In CHF overproduction of ET-1. Which produces vasoconstriction and overload heart and disturb its function. Bosantan is a antagonist of ET-1 receptor and potentially useful in CHF. Recently ,It has been reported that at end stage of CHF ,ET receptor pattern varies of the ETA receptor which would make it interesting to design a drug which act on this receptor.
In addition to the heart device, insulated wires called leads are implanted for two purposes: to carry information signals from your heart to the heart device, and to carry electrical impulses to your heart. Cardiac resynchronisation therapy using a pacing device is recommended as a possible treatment for people with heart failure where all of the following circumstances apply. They have moderate to severe symptoms of heart failure that are affecting their daily life, measuring class 3 or class 4 in the New York Heart Association classification system.
BITS Pilani, Pilani Campus
This approach has uniformly produced positive results using MSCs and CSCs with a number of genetic modifications. Overexpression of the serine/ threonine kinase ,glycogen synthase kinase (GSK)-3 beta enhances therapeutic properties of bone marrow derived MSCs in a mouse model of myocardial infarction. GSK-3 beta overexpression enhances MSC survival after 8 weeks, promotes MSC differentiation into cardiac myocytes.
2 octynyladenosine(YT-146)
2-octynyladenosine(YT-146) is a novel adenosine receptor(AR) agonist and having a cardio protective action. The study for cardiac receptor subtypes involved in the cardioprotective effects of 2-octynyladenosine (YT-146), a novel adenosine receptor (AR) agonist.