Refractory heart failure

Abstract

Managing patients with heart failure is rooted in appropriate recognition of the syndrome and subsequent tailoring of therapies to individual patients based on the stage of the disease. An individual with asymptomatic left ventricular dysfunction (the earliest stage of heart failure) is treated quite differently than a patient with more advanced heart failure manifested by problematic fluid retention, peripheral organ hypoperfusion with dysfunction, and several comorbidities. The latter patient requires aggressive pharmacologic intervention coupled with other creative strategies that are individually tailored to each individual"s unique clinical circumstance. The therapies available include long-term administration of parenteral inotropic therapy, dialysis, insertion of a ventricular assist device, cardiac transplantation, dynamic skeletal myoplasty, volume reduction surgery, or more standard (but higher risk) operative procedures. New drugs are constantly undergoing evaluation and may lead to additional therapeutic improvements in patients with advanced heart failure. The key is recognizing the appropriate place for more radical therapies.

DIGE Proteome Analysis Reveals Suitability of Ischemic Cardiac In Vitro Model for Studying Cellular Response to Acute Ischemia and Regeneration

“…Ischemia and reperfusion injury, resulting from clinical setting of coronary revascularization in acute myocardial infarction, bypass surgery and heart transplantation is a demanding issue. Many dysfunctions and defects have been described to be responsible for the occurrence of ischemic injury; degeneration of cytoskeleton [1], disturbances in calcium homeostasis [2], generation of reactive oxygen species [3], loss of high-energy phosphates [4] and the occurrence of suicidal cell death [5], [6] may play a crucial role in pathogenesis. Treatment of myocardial infarction to restore blood flow to the ischemic region by thrombolysis or coronary artery bypass surgery leads either to hypoxic myocardial tissue, where necrotic and wound-healing process is initiated [7] and contractile function is lost; or blood flow through the myocardium is re-established in time and tissue may regain its function, but may also experience additional damage due to the reperfusion process itself by generation of reactive oxygen species [8], [9].…”