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Chronic Heart Failure (CHF)

CHF, also called congestive heart failure or cardiac failure, is a condition in which the heart is unable to supply sufficient amounts of blood and oxygen to the body. CHF can be caused by conditions that weaken the heart muscle, cause stiffening of the heart muscles, or increase oxygen demand by the body tissue beyond the capability of the heart to deliver. The American Heart Association estimates that approximately 5 million patients in the United States and over 15 million patients worldwide suffer from CHF with over 500,000 new cases diagnosed each year.

Two types of heart failure exist: left ventricular systolic dysfunction and left ventricular diastolic dysfunction. Systolic heart failure occurs with decreased heart contractility resulting in the heart’s inability to pump adequate amounts of blood through the body. As a result, oxygen-rich blood backs up and leaks into the lungs causing pulmonary edema. Diastolic heart failure occurs when the heart is unable to fully relax and properly fill with blood, a stiffening of the cardiac muscle. As a result, fluid accumulates in the feet, ankles, legs and lungs (which condition is called peripheral edema).

A number of symptoms are associated with CHF including shortness of breath (dyspnea), fatigue, fluid accumulation (edema), fluid retention, persistent coughing, and wheezing. Despite significant progress in its treatment over the past decades, CHF remains one of the most life-threatening diseases.

The American College of Cardiology/American Heart Association (ACC/AHA) Heart Failure Guidelines, published in 2001, describe heart failure as a progressive disease. These guidelines identify 4 stages characterized by increasing severity, ranging from conditions at risk for development of heart dysfunction (stage A) to refractory heart failure (stage D).

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Chronic Heart Failure

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Stage	Definition
A	Patients with conditions of high risk for future development of heart failure, but without structural heart abnormalities
B	Patients with structural heart disorder strongly associated with the development of heart failure, who have never presented symptoms or signs of heart failure
C	Patients with current or prior symptoms of heart failure associated with structural heart disease
D	Patients with end-stage heart failure, i.e., severe symptoms despite maximal medical therapy, who require specialized management

Once a person has been diagnosed with heart failure, it's important for them to keep track of symptoms and report any sudden changes to their physician. The American Heart Association lists the following most common signs and symptoms and describes how to recognize them.

Sign or Symptom	Why It Happens	People with Heart Failure May Experience...
Shortness of breath (also called dyspnea)	Blood "backs up" in the pulmonary veins (the vessels that return blood from the lungs to the heart) because the heart can't keep up with the supply. This causes fluid to leak into the lungs.	. . . breathlessness during activity (most commonly), at rest, or while sleeping, which may come on suddenly and wake them up. They often have difficulty breathing while lying flat and may need to prop up the upper body and head on two pillows. They often complain of waking up tired or feeling anxious and restless.
Persistent coughing or wheezing	Fluid builds up in the lungs (see above).	. . . coughing that produces white or pink blood-tinged mucus.
Buildup of excess fluid in body tissues (edema)	As blood flow out of the heart slows, blood returning to the heart through the veins backs up, causing fluid to build up in the tissues. The kidneys are less able to dispose of sodium and water, also causing fluid retention in the tissues.	. . . swelling in the feet, ankles, legs or abdomen or weight gain. They may find that their shoes feel tight.
Tiredness, fatigue	The heart can't pump enough blood to meet the needs of body tissues. The body diverts blood away from less vital organs, particularly muscles in the limbs, and sends it to the heart and brain.	. . . a tired feeling all the time and difficulty with everyday activities, such as shopping, climbing stairs, carrying groceries or walking.
Lack of appetite, nausea	The digestive system receives less blood, causing problems with digestion.	. . . a feeling of being full or sick to their stomach.
Confusion, impaired thinking	Changing levels of certain substances in the blood, such as sodium, can cause confusion.	. . . memory loss and feelings of disorientation. A caregiver or relative may notice this first.
Increased heart rate	To "make up for" the loss in pumping capacity, the heart beats faster.	. . . heart palpitations, which feel like the heart is racing or throbbing.

NanoCor Therapeutics, Inc. is engaged in the development of novel therapeutics for the treatment of various cardiovascular diseases at the molecular level. NanoCor’s lead therapeutic is Carfostin™, an intracellular protein therapeutic for the treatment of Chronic Heart Failure (CHF). Carfostin™ is comprised of the delivery of a therapeutic gene, protein Phosphatase-1 Inhibitor-1 (I-1) with the use of Biological NanoParticles (BNPs™) and the Self-Complementary Vector Technology. This novel approach, which represents an important adjunct to existing therapies, will provide a minimal-invasive treatment for these patients and advance the current standard of care.