Symbolism Of The Scarlet Letter By Nathaniel Hawthorne

Nicholas Markle Mrs. Voshell Honors English 10 6 January 2017 Symbolism in the Scarlet Letter In Nathaniel Hawthorne’s book, The Scarlet Letter, symbolism is used to give the reader an in-depth understanding into the events that take place in the story. There are several symbols that Hawthorne uses to give meaning to the people, places, and things throughout the story. In The Scarlet Letter, Hester Prynne’s husband disappears and is thought to be dead. She has a child with Dimmesdale, Hester’s minister, and the baby’s name is Pearl. The identity of the father is not revealed until later in the story. During Hester’s public shaming for committing adultery, she sees her husband, Chillingworth, in the crowd. Once Hester’s husband finds out†¦show more content†¦She is forced to wear the letter as a sentence for adultery. In the book, it is widely known among the townspeople as a unholy symbol and shun all who are affiliated with it.. The scarlet letter has appeared multiple times in the story in more ways than just appearing on Hester. It appeared in the sky when the comet flew by and it was carved onto Hester and Dimmesdale’s tombstones. To Hester, it was a reminder of her sin, and a punishment that she thought she deserved. To the townspeople, it was a symbol of sin and of how feeble the woman’s mind was. To Dimmesdale, it is a mark of unholy sin and a stain on his mind and spirit. Every time he sees the scarlet letter, he is reminded of his sin. To the reader, it was a symbol of the passion between Hester and Dimmesdale. The next symbol used in the story is Pearl. Pearl is the daughter of Hester and Dimmesdale. She is described as an imaginative child and thought to be the offspring of a demon due to her sudden outbursts of rages and her loud screams, and because of this, she terrified the people. She was always dressed in extravagant outfits, while Hester dressed in plain and dull outfits, with the only decoration was the infamous scarlet lett er. In the context of the book, â€Å"Pearl was the outcome of a sin, of adultery, and was seen as impure.† To Hester, Pearl is a constant reminder of her sin and her adultery. To the townspeople, sheShow MoreRelatedSymbolism In The Scarlet Letter, By Nathaniel Hawthorne1045 Words   |  5 Pages Symbolism is the use of symbols in a book to represent ideas or qualities. Symbolism is used many times throughout The Scarlet Letter, whether it be through a person, an object, or a place. Hester Prynne, Reverend Arthur Dimmesdale, and Roger Chillingworth are some of the more important people that are used as symbols by Nathaniel Hawthorne throughout the book. The Scarlet Letter is set in the Puritan time where Hester is the woman who committed adultery, Arthur is the man who committed adulteryRead MoreSymbolism Of The Scarlet Letter By Nathaniel Hawthorne923 Words   |  4 PagesSymbolism is a common approach used in writing, but it is not to be taken for its exact connota tion. In literature, the symbol can be a person, item, circumstance, or action that has a more profound significance in the writing. In The Scarlet Letter, by Nathaniel Hawthorne there are four main symbols that the reader would notice. The symbols include, the colors red and black, the meteor, Pearl, and the scarlet letter itself. Hawthorne uses symbolism in the novel to communicate his message. In thisRead MoreSymbolism Of The Scarlet Letter By Nathaniel Hawthorne1513 Words   |  7 Pagessomething that is used to represent or stand for something else. Nathaniel Hawthorne was notorious for having used symbolism to portray both spiritual and moral lessons in his works. In fact, what makes some of his stories so great was the symbolism that he used to set the tone or represent key components in the plot. Many of Hawthorne’s works were centered in the Puritan society and dealt with a human’s inclination to sin. Hawthorne realized the many flaws in humans and saw how fake people couldRead MoreSymbolism Of The Scarlet Letter By Nathaniel Hawthorne1956 Words   |  8 Pagesgenerations. For example, the Model T is not produced anymore, but is the grandfather of almost every car made today, affecting jobs, businesses, people, and the world. The Scarlet Letter by Nathaniel Hawthorne is taught today because it was one of the first important American written novels th at contained obvious symbolism. Since symbolism is used in everything of literary merit, it is important to see where it started. In the same way, The Adventures of Sherlock Holmes, by Sir Arthur Conan Doyle has lastedRead MoreSymbolism Of Nathaniel Hawthorne s The Scarlet Letter 1159 Words   |  5 PagesSymbolism in the Scarlet Letter The Scarlet Letter written by Nathaniel Hawthorne is known to have a lot of symbolism. Symbolism is a way to convey ideas and give a book a deeper meaning to readers. While there are many symbols in the Scarlet Letter, there are a few that stand out more than others. Pearl, Hester, Dimmesdale, and Chillingworth are all main characters that have symbols. Hawthorne symbols are used to help readers relate to the story. In order to really comprehend the book the readerRead MoreSymbolism Of Nathaniel Hawthorne s The Scarlet Letter882 Words   |  4 PagesSymbolism in The Scarlet Letter The Scarlet Letter was a novel written in the 1850 s by a man named Nathaniel Hawthorne. Throughout the Scarlet Letter he uses scads of literary devices. The literary devices are there to give the novel more depth. The main device he uses in the novel is symbolism. Hawthorne uses the symbolism to make an object have more than one meaning. Three of the elements he uses as symbols are the scarlet letter, Pearl, and the forest. These symbols are seen differently by theRead MoreThe Symbolism Of Sin In The Scarlet Letter By Nathaniel Hawthorne1086 Words   |  5 PagesNathaniel Hawthorne,   a anti-transcendentalists, born during the early 1800’s, born in Salem, made a book called The Scarlet Letter. The Scarlet Letter was a book about Puritans in New England, during the 1600’s in a small Puritan town. In his novel, The Scarlet Letter, Nathaniel Hawthorne uses symbolism of The Scarlet Letter, Pearl and Burrs to contribute to the overall theme of sin.   Ã‚  Ã‚   To begin, Hawthorne uses The Scarlet Letter to symbolize sin. Hester is the main character in the story, sheRead MoreSymbolism By Nathaniel Hawthorne s The Scarlet Letter1140 Words   |  5 PagesSymbolism; the use of symbols to represent something abstract by something concrete. It can be powerful in a novel when used correctly. Nathaniel Hawthorne’s The Scarlet Letter is a prime example of Symbolism being used creatively in a work.This is what Hyatt H. Waggoner has to say about the Hawthornes creativity.† But in between the surface and the depths movement is constant and complex, and it is in this middle that the principal value of the work lies.†(Waggoner 73)What Waggoner is talking aboutRead MoreSymbolism Of Nathaniel Hawthorne s The Scarlet Letter 1122 Words   |  5 Pagesdraft Topic: Symbolism of the Scarlet letter â€Å"A† In The Scarlet letter the author Nathaniel Hawthorne illustrates the use of symbolism in the book, especially the scarlet letter â€Å"A.† Symbolism is defined as a figure of speech used for an object, or a word to represent something else in literature. The Scarlet letter â€Å"A† had a change of meaning throughout the novel. In the inception of the book it is known as a symbol of Adultery. As the book continues the scarlet letter is looked at differentlyRead MoreSymbolism In The Scarlet Letter, By Nathaniel Hawthorne825 Words   |  4 PagesThe Puritan era in New England was inundated with an atmosphere of righteousness and judgment. This culture spurned those who strayed from its religious codes. In his novel The Scarlet Letter, Nathaniel Hawthorne uses multiple symbols to bring a deeper meaning to the society, his characters, and to adultery. One of the motifs used comes as the character Pearl, the daughter of the two adulterers. Pearl has multiple descriptions ; physically, she is â€Å"a lovely and immortal flower,† yet also â€Å"an airy Symbolism Of The Scarlet Letter By Nathaniel Hawthorne Symbolism is a common approach used in writing, but it is not to be taken for its exact connotation. In literature, the symbol can be a person, item, circumstance, or action that has a more profound significance in the writing. In The Scarlet Letter, by Nathaniel Hawthorne there are four main symbols that the reader would notice. The symbols include, the colors red and black, the meteor, Pearl, and the scarlet letter itself. Hawthorne uses symbolism in the novel to communicate his message. In this Puritan society a group of men and women gather around a door that is heavily timbered with oak, and studded with iron spikes (Hawthorne 51). Hawthorn describes the building as the â€Å"black flower of civilized society (52). This building just so happens to be a prison, which is a vessel that holds people who have committed crime. In the novel, a crime would also be consider sin. Without sin prisons would not be created, a prison needs sin, like a flower needs water. Before a person en ters the prison one notices a wild rose bush, which is red, and also the opposite of a â€Å"black flower†(Hawthorne 52). Hawthorne gives the reader a flower â€Å"we could hardly do otherwise than pluck one of its flowers, and present it to the reader† (Hawthorne 52), as a symbol of the moral in the novel,â€Å"to symbolize some sweet moral blossom that may be found along the track, or relieve the darkening close of a tale of human frailty and sorrow† (Hawthorne 52). The main moral in the novel is people mustShow MoreRelatedSymbolism Of The Scarlet Letter By Nathaniel Hawthorne1464 Words   |  6 PagesNicholas Markle Mrs. Voshell Honors English 10 6 January 2017 Symbolism in the Scarlet Letter In Nathaniel Hawthorne’s book, The Scarlet Letter, symbolism is used to give the reader an in-depth understanding into the events that take place in the story. There are several symbols that Hawthorne uses to give meaning to the people, places, and things throughout the story. In The Scarlet Letter, Hester Prynne’s husband disappears and is thought to be dead. She has a child with Dimmesdale, Hester’sRead MoreSymbolism In The Scarlet Letter, By Nathaniel Hawthorne1045 Words   |  5 Pages Symbolism is the use of symbols in a book to represent ideas or qualities. Symbolism is used many times throughout The Scarlet Letter, whether it be through a person, an object, or a place. Hester Prynne, Reverend Arthur Dimmesdale, and Roger Chillingworth are some of the more important people that are used as symbols by Nathaniel Hawthorne throughout the book. The Scarlet Letter is set in the Puritan time where Hester is the woman who committed adultery, Arthur is the man who committed adulteryRead MoreSymbolism Of The Scarlet Letter By Nathaniel Hawthorne1513 Words   |  7 Pagessomething that is used to represent or stand for something else. Nathaniel Hawthorne was notorious for having used symbolism to portray both spiritual and moral lessons in his works. In fact, what makes some of his stories so great was the symbolism that he used to set the tone or represent key components in the plot. Many of Hawthorne’s works were centered in the Puritan society and dealt with a human’s inclination to sin. Hawthorne realized the many flaws in humans and saw how fake people couldRead MoreSymbolism Of The Scarlet Letter By Nathaniel Hawthorne1956 Words   |  8 Pagesgenerations. For example, the Model T is not produced anymore, but is the grandfather of almost every car made today, affecting jobs, businesses, people, and the world. The Scarlet Letter by Nathaniel Hawthorne is taught today because it was one of the first important Americ an written novels that contained obvious symbolism. Since symbolism is used in everything of literary merit, it is important to see where it started. In the same way, The Adventures of Sherlock Holmes, by Sir Arthur Conan Doyle has lastedRead MoreSymbolism Of Nathaniel Hawthorne s The Scarlet Letter 1159 Words   |  5 PagesSymbolism in the Scarlet Letter The Scarlet Letter written by Nathaniel Hawthorne is known to have a lot of symbolism. Symbolism is a way to convey ideas and give a book a deeper meaning to readers. While there are many symbols in the Scarlet Letter, there are a few that stand out more than others. Pearl, Hester, Dimmesdale, and Chillingworth are all main characters that have symbols. Hawthorne symbols are used to help readers relate to the story. In order to really comprehend the book the readerRead MoreSymbolism Of Nathaniel Hawthorne s The Scarlet Letter882 Words   |  4 PagesSymbolism in The Scarlet Letter The Scarlet Letter was a novel written in the 1850 s by a man named Nathaniel Hawthorne. Throughout the Scarlet Letter he uses scads of literary devices. The literary devices are there to give the novel more depth. The main device he uses in the novel is symbolism. Hawthorne uses the symbolism to make an object have more than one meaning. Three of the elements he uses as symbols are the scarlet letter, Pearl, and the forest. These symbols are seen differently by theRead MoreThe Symbolism Of Sin In The Scarlet Letter By Nathaniel Hawthorne1086 Words   |  5 PagesNathaniel Hawthorne,   a anti-transcendentalists, born during the early 1800’s, born in Salem, made a book called The Scarlet Letter. The Scarlet Letter was a book about Puritans in New England, during the 1600’s in a small Puritan town. In his novel, The Scarlet Letter, Nathaniel Hawthorne uses symbolism of The Scarlet Letter, Pearl and Burrs to contribute to the overall theme of sin.   Ã‚  Ã‚   To begin, Hawthorne uses The Scarlet Letter to symbolize sin. Hester is the main character in the story, sheRead MoreSymbolism By Nathaniel Hawthorne s The Scarlet Letter1140 Words   |  5 PagesSymbolism; the use of symbols to represent something abstract by something concrete. It can be powerful in a novel when used correctly. Nathaniel Hawthorne’s The Scarlet Letter is a prime example of Symbolism being used creatively in a work.This is what Hyatt H. Waggoner has to say about the Hawthornes creativity.† But in between the surface and the depths movement is constant and complex, and it is in this middle that the principal value of the work lies.†(Waggoner 73)What Waggoner is talking aboutRead MoreSymbolism Of Nathaniel Hawthorne s The Scarlet Letter 1122 Words   |  5 Pagesdraft Topic: Symbolism of the Scarlet letter â€Å"A† In The Scarlet letter the author Nathaniel Hawthorne illustrates the use of symbolism in the book, especially the scarlet letter â€Å"A.† Symbolism is defined as a figure of speech used for an object, or a word to represent something else in literature. The Scarlet letter â€Å"A† had a change of meaning throughout the novel. In the inception of the book it is known as a symbol of Adultery. As the book continues the scarlet letter is looked at differentlyRead MoreSymbolism In The Scarlet Letter, By Nathaniel Hawthorne825 Words   |  4 PagesThe Puritan era in New England was inundated with an atmosphere of righteousness and judgment. This culture spurned those who strayed from its religious codes. In his novel The Scarlet Letter, Nathaniel Hawthorne uses multiple symbols to bring a deeper meaning to the society, his characters, and to adultery. One of the motifs used comes as the character Pearl, the daughter of the two adulterers. Pearl has multiple descriptions ; physically, she is â€Å"a lovely and immortal flower,† yet also â€Å"an airy Symbolism Of The Scarlet Letter By Nathaniel Hawthorne A symbol is something that is used to represent or stand for something else. Nathaniel Hawthorne was notorious for having used symbolism to portray both spiritual and moral lessons in his works. In fact, what makes some of his stories so great was the symbolism that he used to set the tone or represent key components in the plot. Many of Hawthorne’s works were centered in the Puritan society and dealt with a human’s inclination to sin. Hawthorne realized the many flaws in humans and saw how fake people could be, so he was able to write truthfully about people and shed a terribly unflattering light on them. The most obvious symbol used in The Scarlet Letter, Hawthorne’s magnum opus, was the scarlet â€Å"A† that Hester Prynne bore on her chest as a reminder of the sin she committed. At the start of the story the â€Å"A† stood for an adulterer and she was obligated to wear it so every one knew what she had done. Hester had a huge decision to make, sh e could have either lived in the shadow of that letter or she could have chosen not to let it define who she was and give the â€Å"A† a new meaning. Hester made the right decision and chose not to be enslaved by her past. She turned the â€Å"A† from a symbol of her mistake and the shame that had been placed upon her, to be positive and standing for â€Å"Able.† Nobody knew who the father of Hester’s child Pearl was for a while. The readers and Roger Chillingworth, Hester’s husband, find out that the man she committed adultery with was ReverendShow MoreRelatedSymbolism Of The Scarlet Letter By Nathaniel Hawthorne1464 Words   |  6 PagesNicholas Markle Mrs. Voshell Honors English 10 6 January 2017 Symbolism in the Scarlet Letter In Nathaniel Hawthorne’s book, The Scarlet Letter, symbolism is used to give the reader an in-depth understanding into the events that take place in the story. There are several symbols that Hawthorne uses to give meaning to the people, places, and things throughout the story. In The Scarlet Letter, Hester Prynne’s husband disappears and is thought to be dead. She has a child with Dimmesdale, Hester’sRead MoreSymbolism In The Scarlet Letter, By Nathaniel Hawthorne1045 Words   |  5 Pages Symbolism is the use of symbols in a book to represent ideas or qualities. Symbolism is used many times throughout The Scarlet Letter, whether it be through a person, an object, or a place. Hester Prynne, Reverend Arthur Dimmesdale, and Roger Chillingworth are some of the more important people that are used as symbols by Nathaniel Hawthorne throughout the book. The Scarlet Letter is set in the Puritan time where Hester is the woman who committed adultery, Arthur is the man who committed adulteryRead MoreSymbolism Of The Scarlet Letter By Nathaniel Hawthorne923 Words   |  4 PagesSymbolism is a common approach used in writing, but it is not to be taken for its exact connotation. In literature, the symbol can be a person, item, circumstance, or action that has a more profound significance in the writing. In The Scarlet Letter, by Nathaniel Hawthorne there are four main symbols that the reader would notice. The symbols include, the colors red and black, the meteor, Pearl, and the scarlet letter itself. Hawthorne uses symbolism in the novel to communicate his message. In thisRead MoreSymbolism Of The Scarlet Letter By Nathaniel Hawthorne1956 Words   |  8 Pagesgenerations. For example, the Model T is not produced anymore, but is the grandfather of almost every car made today, affecting jobs, businesses, people, and the world. The Scarlet Letter by Nathaniel Hawthorne is taught today because it was one of the first important American written novels that contained obvious symbolism. Since symbolism is used in everything of literary merit, it is important to see where it started. In the same way, The Adventures of Sherlock Holmes, by Sir Arthur Conan Doyle has lastedRead MoreSymbolism Of Nathaniel Hawthorne s The Scarlet Letter 1159 Words   |  5 PagesSymbolism in the Scarlet Letter The Scarlet Letter written by Nathaniel Hawthorne is known to have a lot of symbolism. Symbolism is a way to convey ideas and give a book a deeper meaning to readers. While there are many symbols in the Scarlet Letter, there are a few that stand out more than others. Pearl, Hester, Dimmesdale, and Chillingworth are all main characters that have symbols. Hawthorne symbols are used to help readers relate to the story. In order to really comprehend the book the readerRead MoreSymbolism Of Nathaniel Hawthorne s The Scarlet Letter882 Words   |  4 PagesSymbolism in The Scarlet Letter The Scarlet Letter was a novel written in the 1850 s by a man named Nathaniel Hawthorne. Throughout the Scarlet Letter he uses scads of literary devices. The literary devices are there to give the novel more depth. The main device he uses in the novel is symbolism. Hawthorne uses the symbolism to make an object have more than one meaning. Three of the elements he uses as symbols are the scarlet letter, Pearl, and the forest. These symbols are seen differently by theRead MoreThe Symbolism Of Sin In The Scarlet Letter By Nathaniel Hawthorne1086 Words   |  5 PagesNathaniel Hawthorne,   a anti-transcendentalists, born during the early 1800’s, born in Salem, made a book called The Scarlet Letter. The Scarlet Letter was a book about Puritans in New England, during the 1600’s in a small Puritan town. In his novel, The Scarlet Letter, Nathaniel Hawthorne uses symbolism of The Scarlet Letter, Pearl and Burrs to contribute to the overall theme of sin.   Ã‚  Ã‚   To begin, Hawthorne uses The Scarlet Letter to symbolize sin. Hester is the main character in the story, sheRead MoreSymbolism By Nathaniel Hawthorne s The Scarlet Letter1140 Words   |  5 PagesSymbolism; the use of symbols to represent something abstract by something concrete. It can be powerful in a novel when used correctly. Nathaniel Hawthorne’s The Scarlet Letter is a prime example of Symbolism being used creatively in a work.This is what Hyatt H. Waggoner has to say about the Hawthornes creativity.† But in between the surface and the depths movement is constant and complex, and it is in this middle that the principal value of the work lies.†(Waggoner 73)What Waggoner is talking aboutRead MoreSymbolism Of Nathaniel Hawthorne s The Scarlet Letter 1122 Words   |  5 Pagesdraft Topic: Symbolism of the Scarlet letter â€Å"A† In The Scarlet letter the author Nathaniel Hawthorne illustrates the use of symbolism in the book, especially the scarlet letter â€Å"A.† Symbolism is defined as a figure of speech used for an object, or a word to represent something else in literature. The Scarlet letter â€Å"A† had a change of meaning throughout the novel. In the inception of the book it is known as a symbol of Adultery. As the book continues the scarlet letter is looked at differentlyRead MoreSymbolism In The Scarlet Letter, By Nathaniel Hawthorne825 Words   |  4 PagesThe Puritan era in New England was inundated with an atmosphere of righteousness and judgment. This culture spurned those who strayed from its religious codes. In his novel The Scarlet Letter, Nathaniel Hawthorne uses multiple symbols to bring a deeper meaning to the society, his characters, and to adultery. One of the motifs used comes as the character Pearl, the daughter of the two adulterers. Pearl has multiple descriptions ; physically, she is â€Å"a lovely and immortal flower,† yet also â€Å"an airy

Why Everybody Is Talking About Economic Crisis Essay Topics...The Simple Truth Revealed

Why Everybody Is Talking About Economic Crisis Essay Topics...The Simple Truth Revealed What You Can Do About Economic Crisis Essay Topics Beginning in the Next 10 Minutes If you wish to think of the superior essay on microeconomics topics by yourself, the very first place you should search is the internet. In light of the it might be useful if you were able to explain to us why you regard the info and knowledge you've provided as confidential. The collection of effective and very good topics are a few of the first challenges faced by university students who must compose economics essays. The topics covered within this list aren't exhaustive which means there's a broad range of more exclusive areas that ought to be researched. Going through a number of cause and effect essay topics would quickly offer you a firm foot within this venture. The thing to keep in mind is that as soon as you know how to approach essays on economics correctly, you'll find the process interesting and actually enjoyable. Though some may see them as pretty complicated, they are a few of the most straightforward article ideas you will ever encounter. Don't forget that studying isn't always a critical matter and in addition, there are fun cause and effect essay topics you'll be able to refer to. Social issues concern almost every facet of the social order, and thus, in the event you've been assigned an essay within this field, you're in fact given the opportunity to pick from countless topics involving social facets. The environmental field is full of various facets and consequently intriguing cause and effect essay topics. You could struggle to discover the research which aids your argument, and you may also be second-guessing your own understanding. It is necessary for every man or woman to know about basic facts about economics. The Lost Secret of Economic Crisis Essay Topics Essay about financial crisis should outline the principal reasons of the crisis in the nation, its negative results on the financial increase and society well-being. Generally, every crisis provokes the recession in economy, which results in detrimental and drastic changes in the life span of the nation. A debt crisis happens when a country can't pay back or refinance its government debt with no external assistance. Introduction Economic crisis is a wide term used to refer to a variety of financial scenarios. There are quite a lot of facets that add to the growth of the financial crisis. It's only through such actions that the financial needs will shift to defend the environment from harm. There's a close connection between economics and company. Such programme would involve an effort to improve the domestic demand and so causing an expansion of the trade between countries. Citations and extracts from several sources have to be formatted properly. Topics for cause and effect essay could possibly be variable, but the paper presupposes that the author should do a great deal of analyses and discover the root of the problem under review, the explanations for it and the resultant outcomes. A little family essay tree what's architecture essay writing. To begin with, a good essay should clearly highlight its principal idea. In theory, it's easy to recognize the important elements of successful essay writing. Each bit of writing is prepared especially for every customer. You wish to continue to keep notes on ideas you have as you're writing. With this much content out there it's really easy to accidentally copy another work, in spite of the most creative essay ideas. Finding the correct topic to compose a paper on is one of the most essential phases of the writing process. Making a list of the benefits and disadvantages is the ideal beginning to writing an advantages and disadvantages essay about inflation. Top Choices of Economic Crisis Essay Topics Therefore, the government appears to be too generoussince it funds numerous programs and promises to enhance the life span of ordinary men and women. It's quite apparent that quite a few of our decisions rely on the sum of money we have. When a nation isn't getting enough finance or is not getting sufficient money to operate all the essential tasks, then ultimately, the nation do face through the world economic crisis. The occasion to pass on expert knowledge, exchange specialist abilities and t rain together will be a priceless resource. Note you will have lots of chances to get a great job in the industry of law, business, politics, etc. after graduation. Nowadays, many students choose to earn a career in the field of economics. There are particular rules students have to see when they receive a task to write about a financial crisis.

Combination Therapy in Heart Failure Free Essays

The ability of the heart to pump blood Is impaired and It can no longer meet the bodys metabolic requirements Table 1 . New York Heart Association Classiflcation of Heart Failure. Remme W], Swedberg K. We will write a custom essay sample on Combination Therapy in Heart Failure or any similar topic only for you Order Now Guidelines for the diagnosis and treatment of chronic heart failure. European Heart Journal. [Online] 2001; 22(17): 1527-1 560. during the rest or exercisel. By treating HF we try to relieve patients symptoms, Improve their quality of life, prevent hospitalization and most importantly prolong their life. The treatment Includes Improved diet (reduced salt intake), physical activity and pharmacological treatment. There are numerous angiotensin-receptor blockers (ARBs), vasodilators, angiotensin-converting enzyme (ACE) inhibitors Ramipril) and beta-blockers (Carvedilol). We will have a look at the last two classes. They have been PATHOPHYSIOLOGY The previous hemodynamic model was not adequate and was therefore replaced by neurohormonal model, which involves Reninangiotensin-aldosterone-system sympathetic nervous system 1 , (RAAS) 3 is summarized in Figure 1. The activation of RAAS leads to vasoconstriction, oedema and myocardial fibrosis, which are induced by Angiotensin Ill . roven to be very efficient in HF by numerous clinical studies2-4. SYMPTOMS AND SIGNS HF involves many symptoms such as dyspnoea fatigue, and ankle oedema. l The signs of HF are achycardia (100 beats per minute), tachyarrhythmia, tachypnoea, distended Jugular murmur and S3 and S4 heart sounds. The Figure 1 . pathophysiology of heart failure and different levels of therapeutic intervention. Taken from: Perrenoud J]. Heart failure (Part 1). European Geriatric Medicine. [Online] 2011; 2(3): 159-171. ccurrence of these symptoms and signs depends on One of the earliest neurohormonal changes in HF is the severity of heart failure and whether it is caused sympathetic activation and it has a primary role in vein, peripheral oedema, hepatomegaly, heart by systolic dysfunction or diastolic dysfunction . isease progression. Left ventricular remodeling, cell death and changes in gene expression are believed to be the main mechanisms that induce ejection fraction8-11. Because it is very potent, small myocardial doses of the tablet should be taken at the start of damage nervous stimulation 10. treatment (3. 125mg) twice daily. The dose is Heart failure can be categorized in predominantly gradually increased up to maximum of 50mg twice systolic dysfunction where the emptying of the left daily8. ventricle is not optimal and predominantly diastolic dysfunction where the filling of the left ventricle is Molecular targets ot optimall -6. As mentioned above, its major molecular targets are membrane receptors (?l, ?2 and 01). It acts on ion TREATMENT channels (Ca2+ and K+) as well. Carvedilol inhibits As mentioned above, the disease can be treated cardiac voltage-dependent potassium IKr channels using several different drug classes4. Multidrug with high potency, voltage-dependent calcium therapy is widely used in patients with heart failure. channels as well as Ca2+-permeable transient receptor potential (TRP) family channels in Failure Zealand cardiomyocytes and in vascular smooth muscle Carvedilol Trial) have been conducted to test the ells. Furthermore, a study conducted by (Kikuta et benefits of different combinations of drugs. It was al. , 2006) suggests that the drug blocks ATP- proven that these therapies significantly reduce the sensitive (KATP) and G-protein-activated (KG) risk of mortality and improve the symptoms. otassium However, hyperinsulinemia and hypoglycemia. It is believed implementing multi drug therapy. ACE inhibitors that the KG channel is opened by G protein in can cause hypotension, cough, and worsen the renal response to stimulation of G-protein-coupled function. Cough can cause patient noncompliance, uscarinic acetylcholine receptors in atria and sino- which in turn may result in the nee d of different drug therapy. Beta-blockers can cause bradycardia, channel would result in anti-cholinergic effects in hypotension, fatigue and fluid retention. Also, in the heartl 2. Study patients there with Australian-New are risks diabetes, associated beta-blockers channels. This results in could Pharmacodynamics Carvedilol is a racemic mixture of R and S Carvedilol enantiomers. Both enantiomers show al receptor Carvedilol is a non-selective beta-blocker (?l and inhibition. However, only S enantiomer inhibits ? ?2) has drenoreceptors. It competitively blocks both ?l and vasodilatation and antioxidant effects. Previously it ?2 receptors. The drug reduces high blood pressure be mainly due to the al and ? blockage. The inhibition contraindicated in HF as it has negative ionotropic of al receptor lowers total peripheral vascular effect. However, studies have shown that carvedilol resistance. Hence, it reduces afterload and balances in combination with ACE inhibitors improves the negative ionotropic effect the ? inhibition. As a function of the heart, especially left ventricular result, the stroke volume and cardiac output are al-blocker. elieved that Furthermore, carvedilol it should maintained or even increased. The systemic arterial The effects of carvedilol are summarized in figure pressure is lowered without reducing the renal 3. lood flow13-14. The antioxidant effects carvedilol and some of its metabolites are due to the presence of carbazole moiety (shown in Figure 2). In myocardial cell membrane carvedilol inhibits lipid peroxidation. Moreover, endothelial, vascular and neuronal smooth muscle cells from reactive oxygen species. Metabolite SB209995 is much more potent antioxidant than carv edilol itself. Animal studies have shown (Feuerstein et l. , 1998) heart failure imbalances the production of reactive oxygen species and the oxidant defense mechanism. The consequence is an excess of free radicals. This may result in cytotoxic effects as well as cardiovascular remodelingl 3. Figure 3. Molecular targets, pharmacodynamics and clinical implications of carvedilol. Cheng J, Kamiya K, Kodama l. Carvedilol: Molecular and Cellular Basis for its Multifaceted Therapeutic Potential. cardiovascular Drug Revvtevs. coniine] 2006; 19(2): 152-71. Therapeutic efficacy Many different controlled clinical studies were made in order to determine the efficacy of carvedilol. The most known are COPERNICUS, CAPRICORN and USCHFS. They have all shown significant reduction in morbidity and mortality in comparison placebol 5-16. COMET investigating the difference between carvedilol and metoprolol efficacy. The study showed that the allcause mortality was lower with carvedilol (34%) Figure 2. Chemical structure of carvedilol (with postulated active sites) and its active metabolites. * denotes the point of assymetry. Taken from: Cheng J, Kamiya K, Kodama l. Carvedilol: Molecular and Cellular Basis for its Multifaceted Therapeutic Potential. cardiovascular Drug Rewtevs. coniine] 2006; 19(2): 152-71. Carvedilol aids lipid metabolism as it prevents the oxidation of low-density lipoproteins (LDL). It is known that LDL has destructive effects endothelial cells. Carvedilol also inhibits the Renin-angiotensin system (RAS). Hence, the production of Angiotensin II is lowered. Furthermore, studies on cardiac rat myocytes showed that carvedilol enhances the production of nitrite. It is therefore believed that it can increase the NO synthesis through some adrenoreceptor independent mechanism. However, the role of excessive amounts of NO in the diseased heart remains unclear 13-14. than with metoprolol (40%) as shown in figure 417. Figure 4. All-cause Mortality between Carvedilol and Metoprolol. Poole-Wilson PA, Swedberg K, Cleland JGF et al. Comparison of carvedilol and metoprolol on clinical outcomes in patients with chronic heart failure in the Carvedilol or Metoprolol European Trial (COMET): randomized controlled tnal. How to cite Combination Therapy in Heart Failure, Papers