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Cardiac Emergencies in Obstetrics
Published in Sanjeewa Padumadasa, Malik Goonewardene, Obstetric Emergencies, 2021
Sanjeewa Padumadasa, Sanjeewa Rajapakse
Angiotensin-converting enzyme (ACE) inhibitors and angiotensin receptor blockers (ARB) are contraindicated in pregnancy due to fetal toxicity causing neonatal renal failure. However, these can safely be administered during breastfeeding. In women with AF, treatment with beta-blockers and digoxin, and anticoagulation to minimise the risk of thromboembolism, should be considered. In women with heart failure due to pulmonary hypertension, phosphodiesterase type 5 inhibitors such as sildenafil or tadalafil and prostaglandin therapy improve maternal survival. Endothelin receptor antagonists are contraindicated due to teratogenic effects.
The circulatory system
Published in Laurie K. McCorry, Martin M. Zdanowicz, Cynthia Y. Gonnella, Essentials of Human Physiology and Pathophysiology for Pharmacy and Allied Health, 2019
Laurie K. McCorry, Martin M. Zdanowicz, Cynthia Y. Gonnella
Synthesis of endothelin appears to be enhanced by many stimuli including angiotensin II, vasopressin and the mechanical stress of blood flow on the endothelium. Synthesis is inhibited by vasodilator substances, such as prostacyclin, nitric oxide and atrial natriuretic peptide. There is evidence that endothelin is involved with the pathophysiology of many cardiovascular diseases, including hypertension, heart failure, and myocardial infarction. Endothelin receptor antagonists are currently available for research use only.
The right heart
Published in Andrew R. Houghton, MAKING SENSE of Echocardiography, 2013
Treatment options for pulmonary hypertension include identification and treatment of any underlying causes (e.g. valvular heart disease, pulmonary emboli). Oral anticoagulants, diuretics, oxygen therapy, digoxin and calcium-channel blockers may all have a role to play. Endothelin receptor antagonists can also be useful. Surgical options include balloon atrial septostomy or lung/heart–lung transplantation.
Adjuncts to pulsed dye laser for treatment of port wine stains: a literature review
Published in Journal of Cosmetic and Laser Therapy, 2021
Bing Wang, Xianglin Mei, Yanlong Wang, Xin Hu, Fuqiu Li
Endothelin is a bioactive peptide synthesized by endothelial cells that has vasoconstrictive effect, which is associated with the growth of various tumors. It can inhibit cell apoptosis and promote neovascularization. Endothelin receptor antagonists have been shown to exhibit antiangiogenic effects in animal models (47). Accordingly, some scholars speculated that the endothelin receptor antagonist, bosentan, may inhibit PDL-induced angiogenesis in PWS lesions. Under this assumption, it was used in combination with PDL to treat PWS. Four patients with refractory PWS received bosentan 1 day before the PDL treatment and continued it for 14 days. Three patients showed no or only slight improvement, whereas one patient showed a noticeable improvement at the treated area. At 6-month follow-up, the efficacy was maintained. Subsequently, this patient was continued to be treated, and the lesions also showed blanching. This result indicates that some PWS patients may benefit from systematically administered endothelin receptor antagonists to inhibit angiogenesis after PDL treatment (48).
The potential for immune checkpoint modulators in cerebrovascular injury and inflammation
Published in Expert Opinion on Therapeutic Targets, 2021
Jennifer E. Kim, Kisha Patel, Christopher M. Jackson
Therapies targeting the inflammatory cascade have not yet been successfully integrated into the standard aSAH treatment regimen. Nonspecific agents such as steroids, cyclosporine A, and non-steroidal anti-inflammatory drugs (NSAIDs) have had variable success in experimental and clinical trials [154]. Endothelin receptor antagonists that inhibit Endothelin-1 (ET-1) activity also showed initial promise; however clinical trials failed to demonstrate significant outcome benefits [155–159]. Emerging data suggest that immune checkpoints may play a role in aneurysm formation and complications post-hemorrhage. Zhang et al. have published a series of papers associating impaired upregulation of Tim-3 on Tregs with the formation of intracranial aneurysms although the pathogenic mechanism has not yet been elucidated [160–162]. More recently, we found that PD-L1 administration prevented vasospasm in a murine model and this therapeutic effect was abrogated by pretreatment with PD-1 blocking antibodies. Furthermore, changes in PD-1 expression on circulating monocytes predicted TCD elevations and development of clinical vasospasm in a series of aSAH patients [163]. Taken together, these findings implicate PD-1+ monocytes a novel biomarker and therapeutic target for cerebral vasospasm following aSAH, and supports further study of immune checkpoints as mediators of monocyte function during the subacute phase of cerebrovascular injury.
Initial combination therapy for patients with pulmonary arterial hypertension (PAH): a budget impact analysis from the perspective of the Italian national healthcare system
Published in Expert Opinion on Orphan Drugs, 2018
Marco Barbieri, Stefano Ghio, Michele D’Alto, Carlo Albera, Renato Carignola, Massimiliano Mulè, Patrizio Vitulo, Miriam Vighini, Rosaria Silvestri, William Zamboni, Carmine Dario Vizza
Therapy with PAH-approved drugs for incident patients diagnosed with World Health Organization functional class (WHO FC) II–III PAH is appropriate for patients who are either not vasoreactive or vasoreactive but do not respond appropriately to calcium channel blockers [4]. After starting monotherapy with endothelin receptor antagonists (ERAs) or phosphodiesterase type 5 inhibitors (PDE5i), it is necessary to monitor treatment response after 3–4 months. In the case of inadequate clinical response, the addition of another PAH-approved drug that targets a separate pathological pathway is recommended [5]. Clinical response is assessed by right heart function, which is measured by a multiparametric assessment that includes clinical evaluation and invasive (right heart catheterization) and noninvasive (echocardiography and laboratory parameters) tests.