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Maryam, Varghese TP, B T. Unraveling the complex pathophysiology of heart failure: insights into the role of renin-angiotensin-aldosterone system (RAAS) and sympathetic nervous system (SNS). Curr Probl Cardiol 2024; 49:102411. [PMID: 38246316 DOI: 10.1016/j.cpcardiol.2024.102411] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2024] [Accepted: 01/18/2024] [Indexed: 01/23/2024]
Abstract
Heart failure (HF) is a widespread disease with significantly elevated mortality, morbidity, and hospitalization rates. Dysregulation of the sympathetic nervous system (SNS) and renin-angiotensin-aldosterone system (RAAS) are both postulated to be significant regulators of cardiovascular function, thereby playing a pivotal role in its pathophysiology. The RAAS is a sophisticated hormonal system that controls electrolyte homeostasis, fluid balance, and blood pressure. Angiotensin II, which operates to constrict blood vessels and raise blood pressure, is its principal effector molecule. The RAAS is frequently hyperactive in HF, which increases fluid retention and worsens cardiac function. The SNS is frequently hyperactive in heart failure, which increases the workload on the heart and worsens symptoms. This review will discuss what is currently known about the pathophysiology of heart failure, specifically in the context of RAAS and the SNS, in-depth to emphasize the knowledge gap that necessitates more research.
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Affiliation(s)
- Maryam
- Department of Pharmacy Practice, Deccan School of Pharmacy, Nampally, Hyderabad, Telangana, India; Department of Pharmacy Practice, Yenepoya Pharmacy College & Research centre, Yenepoya (Deemed to be University), Ayush campus, Naringana, Deralakatte, Mangalore, Karnataka, India
| | - Treesa P Varghese
- Department of Pharmacy Practice, Yenepoya Pharmacy College & Research centre, Yenepoya (Deemed to be University), Ayush campus, Naringana, Deralakatte, Mangalore, Karnataka, India.
| | - Tazneem B
- Department of Pharmacy Practice, Deccan School of Pharmacy, Nampally, Hyderabad, Telangana, India; Department of Pharmacy Practice, Yenepoya Pharmacy College & Research centre, Yenepoya (Deemed to be University), Ayush campus, Naringana, Deralakatte, Mangalore, Karnataka, India
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Insuficiencia cardiaca aguda. La urgencia cardiológica por excelencia. Rev Esp Cardiol 2022. [DOI: 10.1016/j.recesp.2021.06.029] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
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Peña-Gil C, González-Salvado V, Figueras-Bellot J. Acute heart failure. The quintessential cardiac emergency. REVISTA ESPANOLA DE CARDIOLOGIA (ENGLISH ED.) 2022; 75:9-11. [PMID: 34483064 DOI: 10.1016/j.rec.2021.06.017] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/13/2021] [Accepted: 06/29/2021] [Indexed: 06/13/2023]
Affiliation(s)
- Carlos Peña-Gil
- Servicio de Cardiología y Unidad Coronaria, Hospital Clínico Universitario de Santiago de Compostela, SERGAS, IDIS, Santiago de Compostela, A Coruña, Spain; Centro de Investigación Biomédica en Red de Enfermedades Cardiovasculares (CIBERCV), Spain.
| | - Violeta González-Salvado
- Servicio de Cardiología y Unidad Coronaria, Hospital Clínico Universitario de Santiago de Compostela, SERGAS, IDIS, Santiago de Compostela, A Coruña, Spain; Centro de Investigación Biomédica en Red de Enfermedades Cardiovasculares (CIBERCV), Spain
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Jara González FE, Jimenez Alulima GDF, Sananay Auquilla EL, Murillo Sanclemente JC, Molina Vasquez PA, Vélez Páez JL. Hipercoagulabilidad, trombosis intravascular y trombocitosis asociada al COVID-19. Reporte de un caso. BIONATURA 2020. [DOI: 10.21931/rb/2020.05.02.11] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022] Open
Abstract
Una nueva pandemia en el siglo XXI, generada por un agente viral del tipo coronavirus denominado SARS CoV-2, que produce la enfermedad COVID-19, la misma que debutó a finales del 2019 en China, con una mortalidad importante, que afecta el tracto respiratorio inferior y se manifiesta como neumonía en humanos.
A medida de su expansión mundial, el virus ha presentado mutaciones y por ende variantes fenitípicas que han generado cuadros clínicos que distan mucho de los síntomas descritos inicialmente; más bien, las alteraciones de la coagulación y la intensa inflamación (tormenta de citoquinas) han generado síntomas atípicos y enfoques terapéuticos diferentes; situando a la ferritina y el dímero D como biomarcadores cardinales para decidir anticoagulación y/o terapia anti inflamatoria como corticoterapia, el monoclonal anti IL6 Tocilizumab o el metotrexate, entre otros.
A continuación, presentamos el caso de un paciente diagnosticado de COVID-19 con RT-PCR, que presenta a más de sus manifestaciones respiratorias, un estado protrombótico que desencadenó trombosis intravasculares y posiblemente embolismo pulmonar, con valores elevados de ferritina y dimero D, que luego de anticoagulación y administración de corticoides superó su estado de gravedad extrema y egreso de Terapia Intensiva.
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Raffaello WM, Henrina J, Huang I, Lim MA, Suciadi LP, Siswanto BB, Pranata R. Clinical Characteristics of De Novo Heart Failure and Acute Decompensated Chronic Heart Failure: Are They Distinctive Phenotypes That Contribute to Different Outcomes? Card Fail Rev 2020; 7:e02. [PMID: 33708417 PMCID: PMC7919682 DOI: 10.15420/cfr.2020.20] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/29/2020] [Accepted: 10/23/2020] [Indexed: 12/11/2022] Open
Abstract
Heart failure is currently one of the leading causes of morbidity and mortality. Patients with heart failure often present with acute symptoms and may have a poor prognosis. Recent evidence shows differences in clinical characteristics and outcomes between de novo heart failure (DNHF) and acute decompensated chronic heart failure (ADCHF). Based on a better understanding of the distinct pathophysiology of these two conditions, new strategies may be considered to treat heart failure patients and improve outcomes. In this review, the authors elaborate distinctions regarding the clinical characteristics and outcomes of DNHF and ADCHF and their respective pathophysiology. Future clinical trials of therapies should address the potentially different phenotypes between DNHF and ADCHF if meaningful discoveries are to be made.
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Affiliation(s)
| | - Joshua Henrina
- Siloam Heart Institute, Siloam Hospitals Kebon JerukJakarta, Indonesia
| | - Ian Huang
- Faculty of Medicine, Universitas Pelita HarapanTangerang, Indonesia
- Department of Internal Medicine, Faculty of Medicine, Universitas Padjadjaran, Hasan Sadikin General HospitalBandung, Indonesia
| | | | | | - Bambang Budi Siswanto
- Department of Cardiology and Vascular Medicine, Faculty of Medicine Universitas Indonesia, National Cardiovascular Center Harapan KitaJakarta, Indonesia
| | - Raymond Pranata
- Faculty of Medicine, Universitas Pelita HarapanTangerang, Indonesia
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Xanthopoulos A, Butler J, Parissis J, Polyzogopoulou E, Skoularigis J, Triposkiadis F. Acutely decompensated versus acute heart failure: two different entities. Heart Fail Rev 2019; 25:907-916. [PMID: 31802377 DOI: 10.1007/s10741-019-09894-y] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
Heart failure (HF) has been classified in chronic HF (CHF) and acute HF (AHF). The latter has been subdivided in acutely decompensated chronic HF (ADCHF) defined as the deterioration of preexisting CHF and de novo AHF defined as the rapid development of new symptoms and signs of HF that requires urgent medical attention. However, ADCHF and de novo AHF have fundamental pathophysiological differences. Most importantly, the typical illness trajectory of HF, which is similar to that of other chronic organ diseases including lung, renal, and liver failure, features a gradual decline, with acute episodes usually related to disease evolution followed by partial recovery. Thus, ADCHF should be considered part of the natural history of CHF and renamed CHF exacerbation (CHFE) in accordance with the appropriate terminology used in chronic obstructive pulmonary disease. AHF, in turn, should include only acute de novo HF. The clinical implications of this paradigm shift will be in CHFE the change in focus from in-hospital to optimal ambulatory CHF management aiming at primary and secondary CHFE prevention, while in AHF, the institution of measures for in-hospital limitation of cardiac injury and prevention or retardation of symptomatic CHF development.
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Affiliation(s)
- Andrew Xanthopoulos
- Department of Cardiology, Larissa University General Hospital, P.O. Box 1425, 411 10, Larissa, Greece
| | - Javed Butler
- Department of Medicine, University of Mississippi Medical Center, Jackson, MS, USA
| | - John Parissis
- Heart Failure Unit, Second Cardiology Department, Attikon University Hospital, National and Kapodistrian University of Athens, Athens, Greece
| | - Eftihia Polyzogopoulou
- Emergency Medicine Department, Attikon University Hospital, National and Kapodistrian University of Athens, Athens, Greece
| | - John Skoularigis
- Department of Cardiology, Larissa University General Hospital, P.O. Box 1425, 411 10, Larissa, Greece
| | - Filippos Triposkiadis
- Department of Cardiology, Larissa University General Hospital, P.O. Box 1425, 411 10, Larissa, Greece.
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Hollenberg SM, Warner Stevenson L, Ahmad T, Amin VJ, Bozkurt B, Butler J, Davis LL, Drazner MH, Kirkpatrick JN, Peterson PN, Reed BN, Roy CL, Storrow AB. 2019 ACC Expert Consensus Decision Pathway on Risk Assessment, Management, and Clinical Trajectory of Patients Hospitalized With Heart Failure: A Report of the American College of Cardiology Solution Set Oversight Committee. J Am Coll Cardiol 2019; 74:1966-2011. [PMID: 31526538 DOI: 10.1016/j.jacc.2019.08.001] [Citation(s) in RCA: 199] [Impact Index Per Article: 39.8] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
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Russell FM, Pang PS. Acute Heart Failure Risk Stratification in the Emergency Department: Are We There Yet? REVISTA ESPANOLA DE CARDIOLOGIA (ENGLISH ED.) 2019; 72:190-191. [PMID: 30318186 DOI: 10.1016/j.rec.2018.09.008] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/22/2018] [Accepted: 09/10/2018] [Indexed: 06/08/2023]
Affiliation(s)
- Frances M Russell
- Department of Emergency Medicine, Indiana University School of Medicine, Indianapolis, IN, United States
| | - Peter S Pang
- Department of Emergency Medicine, Indiana University School of Medicine, Indianapolis, IN, United States.
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Russell FM, Pang PS. Estratificación del riesgo en pacientes que acuden a urgencias con fallo cardiaco agudo: ¿estamos preparados? Rev Esp Cardiol (Engl Ed) 2019. [DOI: 10.1016/j.recesp.2018.08.023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
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Choi JJ, McCarthy MW. The prognostic value of mid-regional pro-adrenomedullin in the evaluation of acute dyspnea. Expert Rev Mol Diagn 2018; 18:147-153. [DOI: 10.1080/14737159.2018.1427069] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Affiliation(s)
- Justin J. Choi
- Department of Medicine, Weill Cornell Medical College, New York, USA
| | - Matthew W. McCarthy
- Weill Cornell Medical College, Division of General Internal Medicine, New York-Presbyterian Hospital, New York, NY, USA
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