Sirolimus: a novel immunosuppressive drug in heart transplantation.

Cardiac transplantation is a time-honored therapy for end stage heart disease for a select group of patients. The advances in recent years have increased mean survival to 12 and 13 years. The probability of survival after heart transplantation at one, five and ten years are 80%, 70% and 60% respectively. Calcineurin-inhibitors (CNIs) based regimes have been the corner stone of medical therapy in these patient populations. They have reduced the amount of rejections but with considerably increased toxicities to therapies that decreases long-term patient survival. Proliferation Signal Inhibitors or mammalian target-of-rapamycin inhibitors (PSI/mTOR) are a new class of agents that have been extensively used recently to limit these toxicities. Sirolimus and Everolimus are two such drugs. PSI/mTOR work syngeristically with CNIs or have been as primary immunosuppressant's for patients who do not tolerate or have developed side effects to calcineurin inhibitors. This current article will discuss about sirolimus and its use in heart transplant patients along with outlining some recent patents.

The effect of statins in heart failure: beyond its cholesterol-lowering effect.

BACKGROUND: Statins known as 3-hydroxyl-3-methyl-glutaryl-coenzyme A (HMG-CoA) are designed to lower plasma cholesterol levels. They are used to treat hypercholesterolemia, ischemic heart disease patients, heart transplant recipients, in prevention of Alzheimer's dementia, multiple sclerosis, and have also been shown to reduce cancer risk. METHODS AND RESULTS: The idea of statin treatment in chronic heart failure is not well established. It has been shown to be beneficial in patients with ischemic heart disease with heart failure. Emerging trends show their usefulness in patients with nonischemic heart failure. Statins exhibit pleiotropic effects in stabilizing the atherosclerotic plaques, improvement of endothelial function, inhibition of cell migration and proliferation, and reduction of inflammation and oxidative stress. They also improve autonomic function with an increased parasympathetic drive, downregulate the angiotensin II type I receptors, and induce angiogenesis. CONCLUSION: This article is a review on the current knowledge on statin use in heart failure.

Primary cardiac angiosarcoma: case report and review of the literature.

We report of a young man who was referred for evaluation of the right atrial mass. He had presented outside the hospital with shortness of breath. A transthoracic echocardiogram (TTE) done there showed a bright echodensity in the right atrium with moderate pericardial effusion. He was treated for presumed viral pericarditis. Pericardiocentesis showed a bloody effusion. Four weeks after this initial presentation, a repeat TTE was done to evaluate for recurrent pericardial effusion due to shortness of breath. The right atrial mass had increased in size and no effusion was noted. He was referred to us for further evaluation. The tumor was successfully resected during surgery, and the pathological examination revealed primary cardiac angiosarcoma. The case highlights the misdiagnosis in initial clinical presentation, current diagnostic modalities, and treatment options for cardiac angiosarcoma.

Renal artery stenosis: an update on diagnosis and management.

Reno-vascular disease, along with diabetes mellitus, is the leading cause of dialysis in the elderly population, accounting for 50-66% of cases in patients above 65 years of age. Reno-vascular disease is a broad term, which includes renal artery stenosis, ischemic nephropathy, such as atherosclerotic obstruction, thrombo-embolic phenomenon, nephrosclerosis secondary to hypertension and acute occlusion of renal arteries (either bilateral or unilateral in singlekidney patients). Renal artery stenosis, defined as a 50% or greater occlusion of a renal artery (unilateral or bilateral), is an important cause of secondary hypertension. It often presents as drug refractory hypertension or renal insufficiency. Atherosclerotic renal artery stenosis accounts for 90% of such cases, the remaining 10% being caused by fibro-muscular dysplasia. The incidence of atherosclerotic renal artery stenosis is increasing among the aging population, who are at an increased risk due to cardiovascular complications. This is a review of the emerging trends in the diagnosis and management of renal artery stenosis.