RESUMEN
Chemotherapy has markedly improved cancer outcomes, yet cancer therapy-related cardiac dysfunction (CTRCD) poses a significant challenge, affecting around 10% of patients. CTRCD can be asymptomatic or present with heart failure symptoms. Multimodality imaging, particularly echocardiography, remains pivotal for monitoring cardiac function. Potential biomarkers for CTRCD assessment include troponin and B-type natriuretic peptide. Pharmacological interventions, such as dexrazoxane, angiotensin-converting enzyme inhibitors, and statins, play a crucial role in primary prevention and mitigating cardiotoxicity alongside cardiac rehabilitation programs. Thus, a comprehensive approach is essential for optimal cardiac recovery and improved patient outcomes.
Asunto(s)
Antineoplásicos , Cardiotoxicidad , Cardiopatías , Neoplasias , Recuperación de la Función , Humanos , Neoplasias/tratamiento farmacológico , Antineoplásicos/efectos adversos , Cardiopatías/fisiopatología , Cardiopatías/inducido químicamente , Cardiopatías/diagnóstico , Cardiopatías/diagnóstico por imagen , Cardiopatías/terapia , Cardiopatías/prevención & control , Resultado del Tratamiento , Factores de Riesgo , Rehabilitación Cardiaca , Biomarcadores/sangreRESUMEN
Cisplatin (CP) is a chemotherapy drug widely prescribed to treat various neoplasms. Although fundamental for the therapeutic action of the drug, its cytotoxic mechanisms trigger adverse effects in several tissues, such as the kidney, liver, and heart, which limit its clinical use. In this sense, studies point to an essential role of damage to nuclear and mitochondrial DNA associated with oxidative stress, inflammation, and apoptosis in the pathophysiology of tissue injuries. Due to the limitation of effective preventive and therapeutic measures against CP-induced toxicity, new strategies with potential cytoprotective effects have been studied. Therefore, this article is timely in reviewing the characteristics and main molecular mechanisms common to renal, hepatic, and cardiac toxicity previously described, in addition to addressing the main validated strategies for the current management of these adverse events in clinical practice. We also handle the main promising antioxidant substances recently presented in the literature to encourage the development of new research that consolidates their potential preventive and therapeutic effects against CP-induced cytotoxicity.
Asunto(s)
Antineoplásicos , Cardiotoxicidad , Enfermedad Hepática Inducida por Sustancias y Drogas , Cisplatino , Humanos , Cisplatino/efectos adversos , Antineoplásicos/efectos adversos , Enfermedad Hepática Inducida por Sustancias y Drogas/etiología , Enfermedad Hepática Inducida por Sustancias y Drogas/prevención & control , Enfermedades Renales/inducido químicamente , Enfermedades Renales/prevención & control , Animales , Estrés Oxidativo/efectos de los fármacos , Antioxidantes/farmacología , Antioxidantes/uso terapéutico , Riñón/efectos de los fármacos , Riñón/metabolismo , Riñón/patología , Cardiopatías/inducido químicamente , Cardiopatías/prevención & controlAsunto(s)
Humanos , Choque Cardiogénico/rehabilitación , Corazón Auxiliar/clasificación , Trasplante de Corazón/rehabilitación , Cardiopatías/prevención & control , Cardiopatías/terapia , Ecocardiografía/métodos , Radiografía Torácica/métodos , Fármacos Cardiovasculares/uso terapéutico , Oxigenación por Membrana Extracorpórea/rehabilitación , Contrapulsador Intraaórtico/métodosAsunto(s)
Humanos , Femenino , Mujeres , Cardiopatías/epidemiología , Causas de Muerte , Cardiopatías/prevención & controlRESUMEN
INTRODUCTION: Hypertensive mediated heart disease is the consequence of anatomical and functional changes in cardiovascular system. The benefits on left ventricular (LV) diastolic impairment and remodeling of hypertension treatment are well established. AIM: To evaluate LV structure, systolic and diastolic function of treated hypertensive patients on a medium to long term follow-up. METHODS: Prospectively observational cohort study. Hypertensive patients over 18 years, ultrasound evaluation of LV structure and diastolic and systolic function, follow-up at least once a year. Diastolic function assessed following recommendations of the American Society of Echocardiography and the European Association of Cardiovascular Imaging. RESULTS: 285 patients, mean follow up of 1731 ± 952 days. Sample mean age 56.3 ± 12.5 years, 166 patients (58.3%) were males. Baseline blood pressure 147.8 ± 19/86.8 ± 11 mm Hg, 5 years blood pressure 134.4 ± 15.7/79 ± 9 mm Hg (p < 0.005 SBP and p < 0.01 DBP). Baseline fixed dose combinations 115 patients (40.4%), follow-up 53.1% (p < 0.05). LV remodeling was detected in 88 patients (30.9%) vs. 30.1% at 5 years (p = NS). The frequency of an E/e' ratio > 14 was reduced from 38 patients (13.3%) to 3.6% (p < 0.001), e' septal velocity < 7 cm/sec or e' lateral velocity < 10 cm/sec was reduced from 38.6% (110 patients) to 19.3% (p < 0.001). Baseline normal diastolic function was detected in 85.6% (244 patients) and 94% at the end of the follow-up (p < 0.02). CONCLUSIONS: In this observational cohort followed by a mean of 5 years, the main benefit of hypertension treatment was the prevention or regression of diastolic dysfunction.
Asunto(s)
Antihipertensivos/uso terapéutico , Cardiopatías/etiología , Hipertensión/complicaciones , Hipertensión/tratamiento farmacológico , Adulto , Anciano , Presión Sanguínea/efectos de los fármacos , Diástole/efectos de los fármacos , Femenino , Estudios de Seguimiento , Cardiopatías/fisiopatología , Cardiopatías/prevención & control , Humanos , Hipertensión/fisiopatología , Hipertrofia Ventricular Izquierda/etiología , Hipertrofia Ventricular Izquierda/fisiopatología , Hipertrofia Ventricular Izquierda/prevención & control , Masculino , Persona de Mediana Edad , Estudios Prospectivos , Sístole/efectos de los fármacos , Disfunción Ventricular Izquierda/etiología , Disfunción Ventricular Izquierda/fisiopatología , Disfunción Ventricular Izquierda/prevención & controlRESUMEN
BACKGROUND AND AIMS: It has been demonstrated that maternal low protein during development induces mitochondrial dysfunction and oxidative stress in the heart. Moderate-intensity exercise in early life, conversely, increases the overall cardiac health. Thus, we hypothesize that moderate-intensity exercise performed during young age could ameliorate the deleterious effect of maternal protein deprivation on cardiac bioenergetics. METHODS AND RESULTS: We used a rat model of maternal protein restriction during gestational and lactation period followed by an offspring treadmill moderate physical training. Pregnant rats were divided into two groups: normal nutrition receiving 17% of casein in the diet and undernutrition receiving a low-protein diet (8% casein). At 30 days of age, the male offspring were further subdivided into sedentary (NS and LS) or exercised (NT and LT) groups. Treadmill exercise was performed as follows: 4 weeks, 5 days/week, 60 min/day at 50% of maximal running capacity. Our results showed that a low-protein diet decreases oxidative metabolism and mitochondrial function associated with higher oxidative stress. In contrast, exercise rescues mitochondrial capacity and promotes a cellular resilience to oxidative stress. Up-regulation of cardiac sirtuin 1 and 3 decreased acetylation levels, redeeming from the deleterious effect of protein restriction. CONCLUSION: Our findings show that moderate daily exercise during a young age acts as a therapeutical intervention opposing the harmful effects of a maternal diet restricted in protein.
Asunto(s)
Dieta con Restricción de Proteínas , Cardiopatías/prevención & control , Desnutrición/terapia , Mitocondrias Cardíacas/enzimología , Estrés Oxidativo , Condicionamiento Físico Animal , Efectos Tardíos de la Exposición Prenatal , Sirtuinas/metabolismo , Factores de Edad , Animales , Antioxidantes/metabolismo , Metabolismo Energético , Femenino , Cardiopatías/enzimología , Cardiopatías/fisiopatología , Masculino , Desnutrición/enzimología , Desnutrición/fisiopatología , Fenómenos Fisiologicos Nutricionales Maternos , Estado Nutricional , Embarazo , Ratas Wistar , Especies Reactivas de Oxígeno/metabolismo , Carrera , Factores de TiempoRESUMEN
The innate and adaptive immune systems play an important role in the development of cardiac diseases. Therefore, it has become critical to identify molecules that can modulate inflammation in the injured heart. In this regard, activation of the cholinergic system in animal models of heart disease has been shown to exert protective actions that include immunomodulation of cardiac inflammation. In this mini-review, we briefly present our current understanding on the cardiac cellular sources of acetylcholine (ACh) (neuronal vs. nonneuronal), followed by a discussion on its contribution to the regulation of inflammatory cells. Although the mechanism behind ACh-mediated protection still remains to be fully elucidated, the beneficial immunomodulatory role of the cholinergic signaling emerges as a potential key regulator of cardiac inflammation.
Asunto(s)
Acetilcolina/metabolismo , Antiinflamatorios/uso terapéutico , Cardiotónicos/uso terapéutico , Cardiopatías/metabolismo , Cardiopatías/prevención & control , Corazón/efectos de los fármacos , Acetilcolina/administración & dosificación , Animales , Antiinflamatorios/farmacología , Cardiotónicos/farmacología , Humanos , Inflamación/metabolismo , Inflamación/prevención & control , Neuronas/efectos de los fármacos , Neuronas/metabolismoRESUMEN
INTRODUÇÃO: O envelhecimento associa-se a alterações na estrutura e função do coração, havendo benefícios da prática de exercício físico no retardamento dessas alterações. OBJETIVOS: Caracterizar as alterações ecocardiográficas de uma população idosa submetida à intervenção multidisciplinar incluindo programa de exercício físico adaptado e avaliar as diferenças entre os melhores e piores níveis de adesão à atividade física. MÉTODOS: Estudo de intervenção não randomizado com um grupo de idosos da coorte AGA@4life. Realizaram-se duas avaliações ecocardiográficas, uma basal e outra após a implementação de um programa de intervenção multidisciplinar com um componente de exercício físico por três meses consecutivos. Os participantes foram divididos em dois grupos: grupo 1, com baixa adesão ao programa de exercício físico (< 20% das sessões); grupo 2, com elevada adesão ao programa de exercício físico (> 90% das sessões). RESULTADOS: Na avaliação basal, identificaram-se alterações ecocardiográficas associadas ao envelhecimento 89,2% (n = 33) de casos com fibrose aórtica, 73% (n = 27) de casos com fibrose mitral, 51,2% (n = 19) de casos com regurgitação aórtica e 68% (n = 25) de casos com regurgitação mitral. Após a intervenção, verificaram-se variações significativas em diversos parâmetros funcionais no grupo 2, sobretudo nas velocidades máximas das ondas E' (p = 0,016) e S (p = 0,02) da válvula mitral e da onda E' da válvula tricúspide (p = 0,027). Observaram-se ainda modificações estruturais no grupo 2, nomeadamente redução na espessura parietal relativa (p = 0,033) e no diâmetro diastólico (p = 0,041) do ventrículo esquerdo. CONCLUSÕES: O exercício físico adaptado e implementado no âmbito de um programa de intervenção multidisciplinar constitui uma ferramenta não farmacológica útil para a manutenção de função e estrutura cardíacas adequadas no idoso.
INTRODUCTION: Aging is associated with changes in heart structure and function, and there are benefits of physical exercise in delaying these changes. OBJECTIVES: To characterize the heart of a geriatric cohort at a structural and functional level, and to evaluate the potential cardiac benefits of a personalized exercise intervention program. METHODS: Non-randomized intervention study, including a group of old adults from the AGA@4life cohort. Two echocardiographic evaluations were performed, at baseline and 3 months after the implementation of a multidisciplinary intervention program, integrating the practice of adapted physical exercise. Participants were divided into 2 groups: group 1 with low adherence to the exercise program (< 20% of sessions); group 2 with high adherence to the exercise program (> 90% of sessions). RESULTS: Characteristic heart changes were observed at baseline, mainly at the valvular level, with 89.2% (n = 33) cases of aortic fibrosis, 73% (n = 27) cases of mitral fibrosis, 51.2% (n = 19) cases of aortic regurgitation, and 68% (n = 25) cases of mitral regurgitation. After the intervention, significant changes were observed in several functional parameters in group 2, namely in the maximum velocity of the E' (p = 0.01) and S' (p = 0.02) mitral valve waves, and maximum velocity of the E' tricuspid valve wave (p = 0.02). Positive structural changes were also observed in group 2, namely a reduction in relative wall thickness (p = 0.03) and left ventricular diastolic diameter (p = 0.04). CONCLUSION: Personalized physical exercise implemented as part of a multidisciplinary intervention program is a useful non-pharmacological tool for maintaining adequate cardiac function and structure in the old adult.
Asunto(s)
Humanos , Masculino , Femenino , Persona de Mediana Edad , Anciano , Anciano de 80 o más Años , Envejecimiento/fisiología , Ecocardiografía/métodos , Ejercicio Físico/fisiología , Cardiopatías/prevención & control , Salud del Anciano , Esfuerzo Físico , Corazón/fisiologíaRESUMEN
The presence of hypertensive mediated organ damage is related to increased vascular risk and mortality and its prevention should be a therapeutic target and a surrogate marker of in/adequate blood pressure control. In old adult hypertensive patients the therapeutic target should be to prevent major cardiovascular events, but in young hypertensive subjects the focus should be pointed on preventing the development of hypertensive mediated organ damage, since most of the hard events are preceded by functional and structural tissues injury. Hypertension Guidelines of the European Society of Cardiology and European Society of Hypertension recognizes that some variables like electrocardiographic or echocardiographic left ventricle hypertrophy, chronic kidney disease or advance retinopathy, all considered as hypertensive mediated organ damage, may be modifiers of cardiovascular risk estimated by the SCORE system, and for that reason they should be screened in hypertensive patients. It is well known the problem of limited health systems financial resources in many low and even median income countries which precludes the possibilities of generalizing the search for hypertension mediated organ damage in all hypertensive patients. In these scenario the recommendation to perform a detailed screening should be critically evaluated. Some questions remained unanswered: the screening generalization of hypertensive mediated organ damage should modify the cardiovascular risk score of the patients, if its presence could modify the therapeutic approach, and as a consequence, if the treatment adjustment should prolong life expectancy and ameliorate the quality of life.
Asunto(s)
Antihipertensivos/uso terapéutico , Presión Sanguínea/efectos de los fármacos , Cardiopatías/prevención & control , Hipertensión/tratamiento farmacológico , Enfermedades Renales/prevención & control , Enfermedades Vasculares/prevención & control , Antihipertensivos/efectos adversos , Diagnóstico Precoz , Cardiopatías/diagnóstico , Cardiopatías/mortalidad , Cardiopatías/fisiopatología , Humanos , Hipertensión/diagnóstico , Hipertensión/mortalidad , Hipertensión/fisiopatología , Enfermedades Renales/diagnóstico , Enfermedades Renales/mortalidad , Enfermedades Renales/fisiopatología , Medición de Riesgo , Factores de Riesgo , Factores de Tiempo , Resultado del Tratamiento , Enfermedades Vasculares/diagnóstico , Enfermedades Vasculares/mortalidad , Enfermedades Vasculares/fisiopatologíaRESUMEN
A relação fisiopatológica entre os rins e o coração na doença, conhecida como síndrome cardiorrenal (SCR), envolve distúrbios do coração e dos rins, pois a disfunção aguda ou crônica em um órgão pode induzir a disfunção aguda ou crônica do outro. Em Medicina Veterinária são descritos 5 subtipos de síndrome cardiorrenal: cardiorrenal aguda, cardiorrenal crônica, renocárdica aguda, renocárdica crônica e secundária. A anemia é um achado comum em cães com disfunção cardíaca e renal, caracterizando a chamada síndrome da anemia cardiorrenal. Os mecanismos envolvidos na fisiopatologia da síndrome cardiorrenal envolvem, não somente alterações hemodinâmicas e ativação de sistemas neuro-hormonais, como também a ativação de mecanismos compensatórios do próprio organismo, que acabam contribuindo para a piora da função cardíaca e renal, levando ao desenvolvimento da SCR. O grande desafio encontrado em medicina veterinária está relacionado ao diagnóstico precoce dessa síndrome e, principalmente, ao correto manejo terapêutico, uma vez que que a terapia da cardiopatia pode deteriorar a função renal, e vice-versa. Portanto, é importante compreender como a fisiopatologia de uma doença pode impactar a função do outro órgão. O presente trabalho tem como objetivo trazer uma completa abordagem da fisiopatologia, diagnóstico e tratamento da síndrome cardiorrenal em cães.(AU)
The physiopathological relationship between the kidneys and the heart in the disease, known as cardiorenal syndrome (CRS), involves disorders of the heart and kidneys, since acute or chronic dysfunction in one organ can induce acute or chronic dysfunction of the other. In veterinary medicine, 5 subtypes of cardiorenal syndrome are described: acute cardiorenal, chronic cardiorenal, acute renocardial, chronic and secondary renocardial. Anemia is a common finding in dogs with cardiac and renal dysfunction, characterizing the so-called cardiorenal anemia syndrome. The mechanisms involved in the pathophysiology of the cardiorenal syndrome involve not only hemodynamic changes and activation of neurohormonal systems, but also the activation of compensatory mechanisms of the organism itself, which end up contributing to worsening cardiac and renal function, leading to the development of CRS. The great challenge found in Veterinary Medicine is related to the early diagnosis of this syndrome and, mainly, to the correct therapeutic management, since that the therapy of the cardiopathy can deteriorate the renal function, and vice versa. Therefore, it is important to understand how the pathophysiology of one disease can impact the function of the other organ. The present work aims to bring a complete approach to the pathophysiology, diagnosis and treatment of cardiorenal syndrome in dogs.(AU)
La relación fisiopatológica entre los riñones y el corazón en la enfermedad, conocida como síndrome cardiorrenal (SCR), involucra trastornos cardíacos y renales, ya que la disfunción aguda o crónica en un órgano puede inducir disfunción aguda o crónica en el otro. En medicina veterinaria se describen 5 subtipos de síndrome cardiorrenal: cardiorrenal agudo, cardiorrenal crónico, renocardial agudo, renocardial crónico y secundario. La anemia es un hallazgo común en perros con disfunción cardíaca y renal, que caracteriza el llamado síndrome de anemia cardiorrenal. Los mecanismos involucrados en la fisiopatología del síndrome cardiorrenal implican no solo cambios hemodinámicos y activación de los sistemas neurohormonales, sino también la activación de mecanismos compensatorios del propio cuerpo, que en última instancia contribuyen al empeoramiento de la función cardíaca y renal, lo que conduce al desarrollo de CRS. El principal desafío que se encuentra en la medicina veterinaria está relacionado con el diagnóstico precoz de este síndrome y, especialmente, con el tratamiento terapéutico correcto, ya que la terapia de la enfermedad cardíaca puede deteriorar la función renal y viceversa. Por lo tanto, es importante comprender cómo la fisiopatología de una enfermedad puede afectar la función del otro órgano. El presente trabajo tiene como objetivo brindar un enfoque completo de la fisiopatología, el diagnóstico y el tratamiento del síndrome cardiorrenal en perros.(AU)
Asunto(s)
Animales , Perros , Síndrome Cardiorrenal/prevención & control , Síndrome Cardiorrenal/veterinaria , Anemia/veterinaria , Enfermedades Renales/prevención & control , Enfermedades Renales/veterinaria , Cardiopatías/prevención & control , Cardiopatías/veterinariaRESUMEN
More women die from heart disease than any other illness. This article focuses on risk factors and their prevalence in women along with strategies for preventing this disease. Armed with this information, the NP can play a major role in preventing cardiovascular deaths in women.
Asunto(s)
Cardiopatías/prevención & control , Enfermeras Practicantes , Rol de la Enfermera , Femenino , Humanos , Evaluación en Enfermería , Factores de RiesgoRESUMEN
BACKGROUND/AIMS: Doxorubicin, a chemotherapy drug used successfully for years, could induce cardiotoxicity. Euterpe oleracea Mart. (açai) is a fruit high in antioxidant properties. The aim of this study was to evaluate doxorubicin-induced cardiotoxicity prevention after açai administration. METHODS: A total of 64 male Wistar rats were allocated into 4 groups: control (C), açai (A), doxorubicin (D) and açai-doxorubicin (DA). Rats received regular chow (C and D groups) or chow supplemented with açai 5% (A and DA groups) for 4 weeks. Subsequently, rats received doxorubicin 20 mg/kg (D and DA groups) or saline (C and A groups). Euthanasia was performed 48 hours after doxorubicin injection. Left ventricular function was evaluated by echocardiography in vivo and by isolated heart study ex vivo. Oxidative stress, myocardial metabolism and nitric oxide metabolite were evaluated by spectrophotometry, MMP-2 activity by zymography and caspase-3 and Bcl-2 protein expression by Western blot. RESULTS: Doxorubicin induced decreases in body weight, food and water ingestion. We observed decreases in left ventricular fractional shortening in rats treated with doxorubicin. Additionally, the same rats showed lower +dP/dt and -dP/dt during isolated heart study than those who did not receive doxorubicin. Doxorubicin injection increased caspase-3 protein expression, myocardium lipid hydroperoxide concentration, MMP-2 activity, phosphofructokinase and lactate dehydrogenase activity, and decreased ß-hydroxyacyl-CoA dehydrogenase, pyruvate dehydrogenase, citrate synthase, complex I, complex II and ATP synthase activity in myocardium. Açai supplementation improved left ventricular fractional shortening, decreased myocardium lipid hydroperoxide concentration, MMP-2 activity, and improved ß-hydroxyacyl-CoA dehydrogenase, phosphofructokinase, citrate synthase, complex II and ATP synthase enzymatic activities. We did not observe differences in nitric oxide metabolite concentrations between groups. CONCLUSION: Doxorubicin induced left ventricular dysfunction, increases in oxidative stress, changes in myocardium metabolism and MMP-2 activation. Açai supplementation was able to prevent these alterations.
Asunto(s)
Doxorrubicina/toxicidad , Euterpe/química , Estrés Oxidativo/efectos de los fármacos , Extractos Vegetales/farmacología , Animales , Apoptosis/efectos de los fármacos , Caspasa 3/metabolismo , Suplementos Dietéticos , Ecocardiografía , Euterpe/metabolismo , Cardiopatías/etiología , Cardiopatías/prevención & control , Técnicas In Vitro , L-Lactato Deshidrogenasa/metabolismo , Masculino , Metaloproteinasa 2 de la Matriz/metabolismo , Miocardio/metabolismo , Óxido Nítrico/sangre , Extractos Vegetales/química , Extractos Vegetales/uso terapéutico , Proteínas Proto-Oncogénicas c-bcl-2/metabolismo , Ratas , Ratas Wistar , Función Ventricular Izquierda/efectos de los fármacosRESUMEN
BACKGROUND: Statins can reduce the risk of anthracycline-induced cardiotoxicity. Whether such cardioprotective effects can be seen in trastuzumab-treated patients has not been explored. METHODS: Consecutive women with HER2+ breast cancer who received trastuzumab with or without anthracyclines were identified retrospectively. Patients receiving statins before and during cancer treatment were matched with 2 patients of the same age (± 2 years) and anthracycline exposure status but without statin treatment. The primary outcome was final left ventricular ejection fraction (LVEF). Analysis of covariance (ANCOVA) was used to assess the relationship between statin exposure and the final LVEF. A logistic regression model was constructed to assess the relationship between statin exposure and cardiotoxicity (secondary outcome). RESULTS: Included were 129 patients (62 ± 9 years). Forty-three received statins during cancer treatment. The median trastuzumab exposure time was 11.8 (interquartile range [IQR] 11 to 12) months. Seventy-two (56%) patients received anthracyclines. Compared with controls, patients treated with statins were more likely to have diabetes (37.2% vs 4.7%, P < 0.001), hypertension (58.1% vs 22.1%, P < 0.001), and coronary artery disease (11.6% vs 2.3%, P = 0.04). Within a median cardiac follow-up duration of 11 (IQR 9 to 18) months, the adjusted final LVEF was lower in the control group (61.2% vs 64.6%, P = 0.034). A significant change in LVEF was observed in the control group (median -6%, IQR -10% to -1% P < 0.001) but not in the statin group (median 0%, IQR -5% to +3%, P = 0.27). Upon adjusted analysis, statin treatment was independently associated with a lower risk of cardiotoxicity (odds ratio [OR] 0.32, 95% confidence interval [CI], 0.10-0.99, P = 0.049). CONCLUSIONS: In women with HER2+ breast cancer receiving trastuzumab-based therapy with or without anthracyclines, concomitant use of statins was associated with a lower risk of cardiotoxicity.
Asunto(s)
Neoplasias de la Mama/tratamiento farmacológico , Cardiopatías/prevención & control , Inhibidores de Hidroximetilglutaril-CoA Reductasas/uso terapéutico , Receptor ErbB-2/metabolismo , Trastuzumab/uso terapéutico , Antineoplásicos Inmunológicos/uso terapéutico , Neoplasias de la Mama/complicaciones , Neoplasias de la Mama/metabolismo , Estudios de Casos y Controles , Quimioterapia Combinada , Femenino , Estudios de Seguimiento , Cardiopatías/inducido químicamente , Cardiopatías/fisiopatología , Humanos , Persona de Mediana Edad , Estudios Retrospectivos , Volumen Sistólico/efectos de los fármacos , Trastuzumab/efectos adversos , Función Ventricular Izquierda/efectos de los fármacosRESUMEN
A relação fisiopatológica entre os rins e o coração na doença, conhecida como síndrome cardiorrenal (SCR), envolve distúrbios do coração e dos rins, pois a disfunção aguda ou crônica em um órgão pode induzir a disfunção aguda ou crônica do outro. Em Medicina Veterinária são descritos 5 subtipos de síndrome cardiorrenal: cardiorrenal aguda, cardiorrenal crônica, renocárdica aguda, renocárdica crônica e secundária. A anemia é um achado comum em cães com disfunção cardíaca e renal, caracterizando a chamada síndrome da anemia cardiorrenal. Os mecanismos envolvidos na fisiopatologia da síndrome cardiorrenal envolvem, não somente alterações hemodinâmicas e ativação de sistemas neuro-hormonais, como também a ativação de mecanismos compensatórios do próprio organismo, que acabam contribuindo para a piora da função cardíaca e renal, levando ao desenvolvimento da SCR. O grande desafio encontrado em medicina veterinária está relacionado ao diagnóstico precoce dessa síndrome e, principalmente, ao correto manejo terapêutico, uma vez que que a terapia da cardiopatia pode deteriorar a função renal, e vice-versa. Portanto, é importante compreender como a fisiopatologia de uma doença pode impactar a função do outro órgão. O presente trabalho tem como objetivo trazer uma completa abordagem da fisiopatologia, diagnóstico e tratamento da síndrome cardiorrenal em cães.
The physiopathological relationship between the kidneys and the heart in the disease, known as cardiorenal syndrome (CRS), involves disorders of the heart and kidneys, since acute or chronic dysfunction in one organ can induce acute or chronic dysfunction of the other. In veterinary medicine, 5 subtypes of cardiorenal syndrome are described: acute cardiorenal, chronic cardiorenal, acute renocardial, chronic and secondary renocardial. Anemia is a common finding in dogs with cardiac and renal dysfunction, characterizing the so-called cardiorenal anemia syndrome. The mechanisms involved in the pathophysiology of the cardiorenal syndrome involve not only hemodynamic changes and activation of neurohormonal systems, but also the activation of compensatory mechanisms of the organism itself, which end up contributing to worsening cardiac and renal function, leading to the development of CRS. The great challenge found in Veterinary Medicine is related to the early diagnosis of this syndrome and, mainly, to the correct therapeutic management, since that the therapy of the cardiopathy can deteriorate the renal function, and vice versa. Therefore, it is important to understand how the pathophysiology of one disease can impact the function of the other organ. The present work aims to bring a complete approach to the pathophysiology, diagnosis and treatment of cardiorenal syndrome in dogs.
La relación fisiopatológica entre los riñones y el corazón en la enfermedad, conocida como síndrome cardiorrenal (SCR), involucra trastornos cardíacos y renales, ya que la disfunción aguda o crónica en un órgano puede inducir disfunción aguda o crónica en el otro. En medicina veterinaria se describen 5 subtipos de síndrome cardiorrenal: cardiorrenal agudo, cardiorrenal crónico, renocardial agudo, renocardial crónico y secundario. La anemia es un hallazgo común en perros con disfunción cardíaca y renal, que caracteriza el llamado síndrome de anemia cardiorrenal. Los mecanismos involucrados en la fisiopatología del síndrome cardiorrenal implican no solo cambios hemodinámicos y activación de los sistemas neurohormonales, sino también la activación de mecanismos compensatorios del propio cuerpo, que en última instancia contribuyen al empeoramiento de la función cardíaca y renal, lo que conduce al desarrollo de CRS. El principal desafío que se encuentra en la medicina veterinaria está relacionado con el diagnóstico precoz de este síndrome y, especialmente, con el tratamiento terapéutico correcto, ya que la terapia de la enfermedad cardíaca puede deteriorar la función renal y viceversa. Por lo tanto, es importante comprender cómo la fisiopatología de una enfermedad puede afectar la función del otro órgano. El presente trabajo tiene como objetivo brindar un enfoque completo de la fisiopatología, el diagnóstico y el tratamiento del síndrome cardiorrenal en perros.
Asunto(s)
Animales , Perros , Anemia/veterinaria , Síndrome Cardiorrenal/prevención & control , Síndrome Cardiorrenal/veterinaria , Cardiopatías/prevención & control , Cardiopatías/veterinaria , Enfermedades Renales/prevención & control , Enfermedades Renales/veterinariaRESUMEN
Recent decades have seen an increase in survival rates for cancer patients, partially explained by earlier diagnoses and new chemotherapeutic agents. However, chemotherapy may be associated with adverse cardiovascular events, including hypertension and pulmonary hypertension, supraventricular and ventricular arrhythmias, cardiomyopathy, and other forms of cardiovascular disease. For patients, the benefits of chemotherapy may be partially obfuscated by deleterious effects on the cardiovascular system, resulting in a significant increase in morbidity and mortality. In this article, we review strategies for prevention and treatment of chemotherapy-related cardiotoxicity.