ABSTRACT
Investigations into the mixed muscle-secretory phenotype of cardiomyocytes from the atrial appendages of the heart led to the discovery that these cells produce, in a regulated manner, two polypeptide hormones - the natriuretic peptides - referred to as atrial natriuretic factor or atrial natriuretic peptide (ANP) and brain or B-type natriuretic peptide (BNP), thereby demonstrating an endocrine function for the heart. Studies on the gene encoding ANP (NPPA) initiated the field of modern research into gene regulation in the cardiovascular system. Additionally, ANP and BNP were found to be the natural ligands for cell membrane-bound guanylyl cyclase receptors that mediate the effects of natriuretic peptides through the generation of intracellular cGMP, which interacts with specific enzymes and ion channels. Natriuretic peptides have many physiological actions and participate in numerous pathophysiological processes. Important clinical entities associated with natriuretic peptide research include heart failure, obesity and systemic hypertension. Plasma levels of natriuretic peptides have proven to be powerful diagnostic and prognostic biomarkers of heart disease. Development of pharmacological agents that are based on natriuretic peptides is an area of active research, with vast potential benefits for the treatment of cardiovascular disease.
Subject(s)
Atrial Natriuretic Factor/metabolism , Heart Failure/metabolism , Myocytes, Cardiac/metabolism , Natriuretic Peptide, Brain/metabolism , Receptors, Guanylate Cyclase-Coupled/metabolism , Animals , Atrial Appendage/cytology , Atrial Fibrillation/metabolism , Atrial Natriuretic Factor/genetics , Atrial Natriuretic Factor/physiology , Atrial Remodeling , Biomarkers/metabolism , Cyclic GMP/metabolism , Diabetes Mellitus/metabolism , Fibrosis , Gene Expression Regulation, Developmental , Heart Atria/cytology , Humans , Hypertension/metabolism , Lipid Metabolism/physiology , Metabolic Syndrome/metabolism , Mice , Myocardium/metabolism , Myocardium/pathology , Natriuretic Peptide, Brain/genetics , Natriuretic Peptide, Brain/physiology , Obesity/metabolism , Peptide Fragments/metabolism , Prognosis , Protein Processing, Post-Translational , Pulmonary Arterial Hypertension/metabolism , Secretory Vesicles/metabolism , Ventricular Remodeling , Water-Electrolyte Balance/physiologyABSTRACT
An 80-year-old woman presented with chest pain and dyspnea. The electrocardiogram (ECG) showed a known chronic complete left bundle branch block and elevated levels of high-sensitivity cardiac Troponin T. The first diagnosis was acute coronary syndrome, but a few hours later she developed shock and syncope; after resuscitation a coronary angiography was performed but it did not show any acute coronary obstruction. The echocardiogram showed McConnell's sign suggesting a massive pulmonary embolism; the pulmonary angiography showed large thrombi in both branches of pulmonary artery, so a catheter-based treatment was performed with thromboaspiration and rt-PA administration, and a significant improvement of blood pressure, clinical condition and right ventricle function was observed. In spite of bleeding at the puncture sites (femoral artery and vein), controlled by local compression, catheter-based therapy in massive pulmonary embolism was associated with survival and satisfactory outcome. A combined fragmentation/thromboaspiration and catheter-directed fibrinolysis strategy may be useful to reduce the embolic load, improve RV function, and reduce mortality.
ABSTRACT
Cardiac troponins are pivotal in the evaluation of patients who suffer from acute chest pain, and the introduction of the high-sensitivity cardiac troponins (hs-cTn) has shown that there are differences between male and female patients. Recent recommendations from experts point out that an appropriate evaluation must take into account the patients' sex, but there is no clear evidence of the implementation of this recommendation in the clinical practice, and the matter has sparked controversy. If the same cutoff value is used for both sexes, myocardial infarction in men might be overdiagnosed, especially in the elderly, who have relatively higher values, and might be underdiagnosed in most women. The International Federation of Clinical Chemistry and Laboratory Medicine Task Force on Clinical Applications of Cardiac Bio-Markers (IFCCLM, TF-CB) 2018 and the Fourth Universal Definition of Acute Myocardial Infarction support the overall and sex-specific 99th percentile Upper Reference Limit (URL) cutoff value, but based on the definition of hs-cTn assays, the Limit of Detection (LoD) may be considered a starting point for an assessment method that does not differentiate between the levels of hs-cTn in male and female patients suspected of suffering from acute coronary syndrome (ACS). In this paper, we discuss the evidence and a novel strategy based on hs-cTn for rapidly ruling out myocardial infarction in low-risk patients who suffer from acute chest pain.
Subject(s)
Chest Pain/blood , Myocardial Infarction/diagnosis , Troponin/blood , Biomarkers/blood , Chest Pain/diagnosis , Chest Pain/etiology , Diagnosis, Differential , Humans , Myocardial Infarction/blood , Myocardial Infarction/complications , Reproducibility of Results , Sex FactorsABSTRACT
Since their discovery in 1981, the cardiac natriuretic peptides (cNP) atrial natriuretic peptide (also referred to as atrial natriuretic factor) and brain natriuretic peptide have been well characterised in terms of their renal and cardiovascular actions. In addition, it has been shown that cNP plasma levels are strong predictors of cardiovascular events and mortality in populations with no apparent heart disease as well as in patients with established cardiac pathology. cNP secretion from the heart is increased by humoral and mechanical stimuli. The clinical significance of cNP plasma levels has been shown to differ in obese and non-obese subjects. Recent lines of evidence suggest important metabolic effects of the cNP system, which has been shown to activate lipolysis, enhance lipid oxidation and mitochondrial respiration. Clinically, these properties lead to browning of white adipose tissue and to increased muscular oxidative capacity. In human association studies in patients without heart disease higher cNP concentrations were observed in lean, insulin-sensitive subjects. Highly elevated cNP levels are generally observed in patients with systolic heart failure or high blood pressure, while obese and type-2 diabetics display reduced cNP levels. Together, these observations suggest that the cNP system plays a role in the pathophysiology of metabolic vascular disease. Understanding this role should help define novel principles in the treatment of cardiometabolic disease.
Subject(s)
Humans , Angioplasty , Electrocardiography , Myocardial Reperfusion , Acute Disease , Fibrinolytic AgentsSubject(s)
Humans , Myocardial Reperfusion , Electrocardiography , Angioplasty , Fibrinolytic Agents , Acute DiseaseSubject(s)
Humans , Fibrinolytic Agents/administration & dosage , Angina, Unstable/classification , Myocardial Infarction/classification , Myocardial Infarction/diagnosis , Acute Coronary Syndrome/physiopathology , Acute Coronary Syndrome/drug therapy , Acute Coronary Syndrome/therapy , Coronary Angiography , Cineangiography , Intra-Aortic Balloon Pumping , Platelet Aggregation Inhibitors/administration & dosageABSTRACT
The prevalence of acute coronary syndromes (ACS) throughout the world has been a stimulus for the development of chest pain centers beyond the United States, where the concept first emerged. The rationale for the development of chest pain centers in Argentina includes the abundance of ACS and the objective of optimizing healthcare delivery.
ABSTRACT
El aporte rápido de volumen es vital para la recuperación inicial del shock hipovolémico. Para determinar el flujo de solución de Ringer y sangre entera, se testearon tres tipos diferentes de catéteres de longitud progresivamente mayor: N§ 18 para vena periférica, N§ 9 para subclavia y K 31 para subclavia o flebotomía. Se dejó perfundir por gravedad o aplicando 200 mmHg de presión al sachet y se midió el volumen emitido en un minuto dentro de una probeta graduada. Se observó que en un catéter más corto, el flujo era significativamente mayor que el de los catéteres más largos (p<0,0001), tanto para la solución cristaloide como para la sangre; también, el flujo aumentó significativamente en todos los catéteres cuando se aplicó presión (p<0.0001). En el tratamiento del shock hipovolémico, y con el material con que habitualmente se cuenta, sería recomendable canalizar con un catéter corto del mayor diámetro interno posible, una vena periférica para aportar volumen a presión constante; colocar una vía central para medir PVC y como vía accesoria de aporte, no principal, ya que un catéter corto proporciona un flujo significativamente mayor
Subject(s)
Humans , Fluid Therapy , In Vitro Techniques , Shock, Hemorrhagic/therapy , Blood Transfusion/instrumentation , Outflow Velocity Measurement , Catheterization, Peripheral/instrumentation , Catheterization, Peripheral/methods , Infusions, Parenteral , RheologyABSTRACT
El aporte rápido de volumen es vital para la recuperación inicial del shock hipovolémico. Para determinar el flujo de solución de Ringer y sangre entera, se testearon tres tipos diferentes de catéteres de longitud progresivamente mayor: Nº 18 para vena periférica, Nº 9 para subclavia y K 31 para subclavia o flebotomía. Se dejó perfundir por gravedad o aplicando 200 mmHg de presión al sachet y se midió el volumen emitido en un minuto dentro de una probeta graduada. Se observó que en un caté
