Gene/Protein Disease Symptom Drug Enzyme Compound
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Query: UMLS:C0018801 (heart failure)
 72,216 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

Many advances have been made in the cardiovascular field in the last several decades. Among them is the progress completed to date on the heptapeptide member of the renin-angiotensin system (RAS), angiotensin-(1-7) [Ang-(1-7)]. The peptide's beneficial actions against pathophysiological processes, such as cardiac arrhythmia, heart failure, hypertension, renal disease, preeclampsia, and even cancer are continuously being uncovered. This review encompasses the pharmacology of Ang-(1-7) and expounds upon the peptide's potential as a therapeutic agent against pathological processes both within and outside the cardiovascular continuum.
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PMID:Angiotensin-(1-7): pharmacology and new perspectives in cardiovascular treatments. 1761 38

Peripartum cardiomyopathy (PC) and preeclampsia with HELLP syndrome are serious complications of pregnancy, but the coincidence of both in one pregnancy is extremely rare. Here, we report a case of 32-year-old primipara who in 35th Hbd presented for the first time in her life symptoms of severe heart failure (HF) in NYHA class III/IV. In 37th Hbd the diagnosis of PC was established based on clinical status and echocardiographic examination, which demonstrated a dilatation of heart chambers and impaired left ventricular systolic function with decreased ejection fraction (EF) 17%. In 37th Hbd she developed symptoms of preeclampsia complicated with HELLP syndrome (hemolysis, elevated liver enzymes, low platelets) and further a DIC syndrome as well. Because the patient was in critical condition and the foetus' life was threatened the pregnancy was terminated with urgent cesarean section. Then the patient developed shock, respiratory insufficiency and increasing renal failure. Successful treatment, included administration of pressor amines, respirator, hemodialyses, multiple fresh frozen plasma and blood transfusions. The symptoms of HELLP syndrome resolved by 9th day of treatment. Although optimal treatment of HF was administered with significant clinical improvement, the normalization of left ventricle systolic function was not observed. At 2 and 13 months follow-up, EF remained low and was 34 and 36% respectively. This allows to diagnose persistent PC. Based on the case, the issues of etiopathogenesis, treatment, prognosis and the risk of recurrence of PC and HELLP syndromes in a possible pregnancy are discussed.
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PMID:[Peripartum cardiomyopathy and preeclampsia complicated with HELLP syndrome--a case report]. 1841 98

A 35-year-old Sri Lankan woman (gravida 3, para 3, abortus 0) presented to the Jewish General Hospital (Montreal, Quebec) with shortness of breath and diffuse swelling. She was five months postpartum of her most recent delivery, which was complicated by pre-eclampsia and gestational diabetes. She described a three-week history of progressive exertional dyspnea, orthopnea and paroxysmal nocturnal dyspnea. There was no history of recent viral illness, and the patient had no traditional risk factors for coronary artery disease. A physical examination, laboratory results and echocardiography were typical for heart failure. A presumptive diagnosis of peripartum cardiomyopathy was made. To initiate a transplant referral, coronary angiography was performed. Six discrete atherosclerotic lesions were found, notably left main equivalent disease. A diagnosis of ischemic cardiomyopathy was made, and the patient was referred for high-risk coronary artery bypass surgery and transplant. The present case illustrates the excess burden of coronary artery disease borne in south Asian patient populations.
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PMID:A young woman with dyspnea. 1861 6

Homocysteine is a sulfur amino acid whose metabolism stands at the intersection of two pathways: remethylation, which requires folic acid and vitamin B12 coenzymes; and transsulfuration, which requires pyridoxal-5'-phosphate, the vitamin B6 coenzyme. Data from a number of laboratories suggest that mild elevations of homocysteine in plasma are a risk factor for occlusive vascular disease. In the Framingham studies, we have shown that plasma homocysteine concentration is inversely related to the intake and plasma levels of folate and vitamin B6 as well as vitamin B12 plasma levels. Almost two-thirds of the prevalence of high homocysteine is attributable to low vitamin status or intake. Elevated homocysteine concentrations in plasma are a risk factor for prevalence of extracranial carotid-artery stenosis > or = 25% in both men and women. Prospectively elevated plasma homocysteine is associated with increased total and cardiovascular mortality, increased incidence of stroke, increased incidence of dementia and Alzheimer's disease, increased incidence of bone fracture, and higher prevalence of chronic heart failure. It was also shown that elevated plasma homocysteine is a risk factor for preeclampsia and maybe neural tube defects (NTD). This multitude of relationships between elevated plasma homocysteine and diseases that afflict the elderly, pregnant women, and the embryo points to the existence ofa common denominator which may be responsible for these diseases. Whether this denominator is homocysteine itself or homocysteine is merely a marker, remains to be determined.
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PMID:Public health significance of elevated homocysteine. 1870 86

Cardiovascular disease (CVD) remains the leading cause of morbidity and premature mortality in both women and men in most industrialized countries, and has for some time also established a prominent role in developing nations. In fact, obesity, diabetes mellitus and hypertension are now commonplace even in children and youths. Regular exercise is rapidly gaining widespread advocacy as a preventative measure in schools, medical circles and in the popular media. There is overwhelming evidence garnered from a number of sources, including epidemiological, prospective cohort and intervention studies, suggesting that CVD is largely a disease associated with physical inactivity. A rapidly advancing body of human and animal data confirms an important beneficial role for exercise in the prevention and treatment of CVD. In Part 1 of this review we discuss the impact of exercise on CVD, and we highlight the effects of exercise on (i) endothelial function by regulation of endothelial genes mediating oxidative metabolism, inflammation, apoptosis, cellular growth and proliferation, increased superoxide dismutase (SOD)-1, down-regulation of p67phox, changes in intracellular calcium level, increased vascular endothelial nitric oxide synthase (eNOS), expression and eNOS Ser-1177 phosphorylation; (ii) vascular smooth muscle function by either an increased affinity of the Ca2+ extrusion mechanism or an augmented Ca2+ buffering system by the superficial sarcoplasmic reticulum to increase Ca2+ sequestration, increase in K+ channel activity and/or expression, and increase in L-type Ca2+ current density; (iii) antioxidant systems by elevation of Mn-SOD, Cu/Zn-SOD and catalase, increases in glutathione peroxidase activity and activation of vascular nicotinamide adenine dinucleotide phosphate [(NAD(P)H] oxidase and p22phox expression; (iv) heat shock protein (HSP) expression by stimulating HSP70 expression in myocardium, skeletal muscle and even in human leucocytes, probably through heat shock transcription factor 1 activity; (v) inflammation by reducing serum inflammatory cytokines such as high-sensitivity C-reactive protein (hCRP), interleukin (IL)-6, IL-18 and tumour necrosis factor-alpha and by regulating Toll-like receptor 4 pathway. Exercise also alters vascular remodelling, which involves two forms of vessel growth including angiogenesis and arteriogenesis. Angiogenesis refers to the formation of new capillary networks. Arteriogenesis refers to the growth of pre-existent collateral arterioles leading to formation of large conductance arteries that are well capable to compensate for the loss of function of occluded arteries. Another aim of this review is to focus on exercise-related cardiovascular protection against CVD and associated risk factors such as aging, coronary heart disease, hypertension, heart failure, diabetes mellitus and peripheral arterial diseases mediated by vascular remodelling. Lastly, this review examines the benefits of exercise in mitigating pre-eclampsia during pregnancy by mechanisms that include improved blood flow, reduced blood pressure, enhanced placental growth and vascularity, increased activity of antioxidant enzymes, reduced oxidative stress and restored vascular endothelial dysfunction.
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PMID:Exercise, vascular wall and cardiovascular diseases: an update (Part 1). 1902 18

Cardiovascular function is modulated by neuronal transmitters, circulating hormones, and factors that are released locally from tissues. Urotensin II (UII) is an 11 amino acid peptide that stimulates its' obligatory G protein coupled urotensin II receptors (UT) to modulate cardiovascular function in humans and in other animal species, and has been implicated in both vasculoprotective and vasculopathic effects. For example, tissue and circulating concentrations of UII have been reported to increase in some studies involving patients with atherosclerosis, heart failure, hypertension, preeclampsia, diabetes, renal disease and liver disease, raising the possibility that the UT receptor system is involved in the development and/or progression of these conditions. Consistent with this hypothesis, administration of UT receptor antagonists to animal models of cardiovascular disease have revealed improvements in cardiovascular remodelling and hemodynamics. However, recent studies have questioned this contributory role of UII in disease, and have instead postulated a protective effect on the cardiovascular system. For example, high concentrations of circulating UII correlated with improved clinical outcomes in patients with renal disease or myocardial infarction. The purpose of this review is to consider the regulation of the cardiovascular system by UII, giving consideration to methodologies for measurement of plasma concentrations, sites of synthesis and triggers for release.
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PMID:Urotensin II in cardiovascular regulation. 1906 95

The peripartum cardiomyopathy is a rare form of dilated cardiomyopathy. Its etiology remains unclear and is likely multifactorial. The diagnosis is based on the association of clinical heart failure and systolic dysfunction assessed by echocardiography or magnetic resonance imaging. Diagnosis to rule out are myocardial infarction, myocarditis, inherited cardiomyopathy, history of treatment by anthracycline. Risk factors are advance maternal age (> 30), multiparity, twin pregnancy, african origin, obesity, pre-eclampsia, gestational hypertension, and prolonged tocolytic therapy. Treatment of acute phase is identical to usual treatment of acute systolic heart failure. Angiotensin converting enzyme inhibitor and VKA are contra indicated during pregnancy. After delivery, VKA treatment should be discussed in case of systolic function < 25 % because of higher risk of thrombus. Complete recovery of systolic function is observed in 50 % of the case. The mortality risk is low. Subsequent pregnancy should be discouraged, especially if systolic function did not recover.
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PMID:[Peripartum cardiomyopathy]. 1942 62

Pregnancy still constitutes a major challenge for women with systemic lupus erythematosus. Coordinated medical/obstetric care is essential to maximise the chance of success. Pregnancy should be planned in advance, following a pre-conceptional visit in which the specific risk for complications can be assessed. Previous complicated pregnancies, renal disease, irreversible damage, anti-phospholipid antibodies and treatment with high-dose steroids are adverse features. Pregnancy should be discouraged in women with symptomatic pulmonary hypertension, heart failure, severe restrictive pulmonary disease, severe chronic renal failure and recent serious lupus activity. Treatment is based on hydroxychloroquine, low-dose steroids, azathioprine and in patients with anti-phospholipid antibodies, low-dose aspirin+/-low molecular weight heparin. Close surveillance, with monitoring of blood pressure, proteinuria and placental blood flow by Doppler studies helps the early diagnosis and treatment of complications such as pre-eclampsia and foetal distress. Post-partum follow-up is also essential.
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PMID:Managing lupus patients during pregnancy. 1959 86

Human gene 2 relaxin (RLX) is a member of the insulin superfamily and is a multi-functional factor playing a vital role in pregnancy, aging, fibrosis, cardioprotection, vasodilation, inflammation, and angiogenesis. RLX is currently applied in clinical trials to cure among others acute heart failure, fibrosis, and preeclampsia. The synthesis of RLX by chemical methods is difficult because of the insolubility of its B-chain and the required laborious and low yielding site-directed combination of its A (RLXA) and B (RLXB) chains. We report here that oxidation of the Met(25) residue of RLXB improves its solubility, allowing its effective solid-phase synthesis and application in random interchain combination reactions with RLXA. Linear Met(O)(25)-RLX B-chain (RLXBO) reacts with a mixture of isomers of bicyclic A-chain (bcRLXA) giving exclusively the native interchain combination. Applying this method Met(O)(25)-RLX (RLXO) was obtained in 62% yield and was easily converted to RLX in 78% yield, by reduction with ammonium iodide.
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PMID:An optimized chemical synthesis of human relaxin-2. 2019 7

Chorangioma has been referred to as a hamartoma-like, or a hyperplastic capillary lesion, rather than a true neoplasm. Its incidence is 1 in 100 placentas. In chorangiomas larger than 4 cm, there can be significant effects on the hemodynamic and circulatory processes of the fetus, leading to grave clinical consequences, such as polyhydramnios and fetal heart failure. Chorangiomas can show various histopathologic pictures, ranging from vascular to cellular, and can undergo degenerative changes. They can be diagnosed prenatally by ultrasound, color Doppler imaging, and magnetic resonance imaging (MRI). Chorangioma must be differentiated from other villous capillary lesions, namely, chorangiomatosis and chorangiosis. They have overlapping similarities with chorangioma, and have clinical implications. Chorangiomatosis has been associated with negative fetal outcomes such as intrauterine growth retardation (IUGR) and preeclampsia. Chorangiosis is associated with maternal diabetes mellitus. Another rarer differential is chorangioma with trophoblast proliferation ("chorangiocarcinoma," a probable misnomer), a rare proliferation of trophoblastic tissue seen in the vicinity of otherwise benign chorangioma. Treatment modalities of chorangioma include endoscopic devascularization, alcoholic ablation, and interstitial laser coagulation. In this article, we will review the clinical and pathologic picture of chorangioma as well as treatment, and discuss its main differentials.
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PMID:Chorangioma and related vascular lesions of the placenta--a review. 2059 43


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