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The pathogenesis of cardiogenic shock (CS) has evolved from an acute event due to a large myocardial infarction to a semiacute event due to rapid hemodynamic deterioration on a background of preexisting left ventricular systolic dysfunction. Pre-CS refers to the period of rapid hemodynamic deterioration that precedes overt CS with hypotension, inflammatory response, and end-organ failure. Mortality remains extremely high in CS and has not improved over the past decades. Pre-CS offers a unique opportunity to initiate early treatment that may result in better clinical outcomes. The present review addresses the definition, recognition, and management of pre-CS with the pharmacologic or mechanical support of the failing left ventricle.

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The objective of the present research work was to design, develop and optimize Letrozole loaded polymeric nanoparticles in order to potentially maximize the therapeutic efficiency, to decrease toxicity as well as to minimize the drug side effects. Pectin and Tween 80 were used as polymer and surfactants respectively. Letrozole polymeric nanoparticles (LTZ-PNPs) were prepared by precipitation method. The drug-polymer compatibility was studied using Fourier Transform Infrared (FTIR) and Differential Scanning Microscopy (DSC). The formulations' optimization was done by design expert. The drug content (DC) and entrapment efficiency (EE) of nanoparticles (NPs) were evaluated by UV-Vis microscopy. The particle size of NPs were investigated using dynamic light scattering technique. The Franz diffusion cell was used for In-Vitro drug release studies. Accelerated stability studies were performed as per ICH guidelines. FTIR and DSC studies revealed compatibility between Letrozole and pectin. The DC was found to be uniform within all formulations (95%) and 96.87 % for the optimized formulation (F9). The E.E was found to be in the range of 68.87 to 95.11%. The NPs particle size was between 194 nm and 333 nm; F9 showed the particle size of 218.5 nm. Drug release from all formulated NPs followed nonfickian transport, thus the release mechanism was diffusion. The optimized formulation did not show a large variation in DC and EE when stored at 40 °C/75% RH as per ICH guidelines.