RESUMO
Pharmacological therapy of systolic left ventricular dysfunction has evolved over the past 3 decades. Current therapy is focused primarily on the regulation of the renin-angiotensin-aldosterone axis and sympathetic nervous system. Additional targets of pharmacotherapy include vasoconstriction, impaired nitric oxide metabolism, inflammation and improving myocardial function. As therapies in chronic systolic heart failure have evolved beyond diuretics and digoxin, so too has mortality improved. Future directions in the management of heart failure include cell-based and genetic therapy, and further refinement of current therapy through genetics.
Assuntos
Antagonistas Adrenérgicos beta/uso terapêutico , Bloqueadores do Receptor Tipo 1 de Angiotensina II/uso terapêutico , Inibidores da Enzima Conversora de Angiotensina/uso terapêutico , Insuficiência Cardíaca Sistólica/tratamento farmacológico , Sistema Nervoso Simpático/efeitos dos fármacos , Insuficiência Cardíaca Sistólica/fisiopatologia , Humanos , Sistema Renina-Angiotensina/efeitos dos fármacos , Sistema Renina-Angiotensina/fisiologia , Sistema Nervoso Simpático/fisiologiaRESUMO
SUMMARY: Obesity is a major health concern worldwide as obese individuals have a greater risk of death from any cause than normal-weight individuals. As the number of overweight children and adolescents continues to rise, so too has the scope of the obesity epidemic grown substantially. In this article, the authors discuss the role of obesity in the development of heart failure and the pathophysiology of obesity cardiomyopathy, as well as explore the potential role of bariatric surgery and mechanical circulatory support devices (MCSD) as potential therapeutic targets.: