Lecture 2 Cardiovascular System 2023 PDF

Phytotherapy and Cardiovascular System Lecture 2 Assoc. Prof. Noha Swilam [email protected] Lecture Content Phytomedicines and Cardiovascular System 1. Phytotherapy of Congestive Heart Failure 4. Phytotherapy of Chronic...

Phytotherapy and Cardiovascular System Lecture 2 Assoc. Prof. Noha Swilam [email protected] Lecture Content Phytomedicines and Cardiovascular System 1. Phytotherapy of Congestive Heart Failure 4. Phytotherapy of Chronic Venous Hawthorn (Crataegus spp) Insufficiency Horse chestnut 2. Phytotherapy of Angina French maritime pine (Pycnogenol) Hawthorn (Crataegus spp) Butcher's broom Panax ginseng (ginseng) Gotu kola (hydrocotyle) Salvia miltiorrhiza (danshen) Bilberry Chronic Venous Insufficiency 3. Phytotherapy of Hypertension Hemorrhoids Garlic Mucilage-containing herbs Snakeroot (or rauwolfia) horse-chestnut and butcher's broom Veratrum plants White hellebore Witch hazel 5. Arterial Occlusive Diseases Ginkgo  Cardiovascular Problems 1. Congestive Heart Failure 2. Atherosclerosis 3. Angina  Congestive Heart Failure (CHF) Congestive heart failure, or heart failure Etiology: Gradual reduction in heart functions Decrease in the inotropic activity of the heart along together with a substantial decrease in cardiac output and a generalized edema of the body. Symptoms and Causes Shortness of breath Coronary artery disease and/or heart attack Chest pain Cardiomyopathy (genetic) Heart palpitations Congenital heart disease Fatigue when you’re active Diabetes Swelling in your ankles, legs and abdomen High blood pressure (hypertension) Weight gain Arrhythmia A dry cough A body mass index (BMI) higher than 30. A full (bloated) or hard stomach Tobacco and alcohol use  Congestive Heart Failure (CHF) Functional Classification of CHF Class Functional Capacity Patients without limitation of physical activity. They suffer no symptoms from I ordinary activities. Patients with slight limitation of physical capacity, in which ordinary physical activity leads II to fatigue, palpitations, they are comfortable at rest. Patients with marked limitation of physical activity, in which less than ordinary activity III results in fatigue, palpitation, angina pain; they are comfortable only at rest. Patients who are not only unable to carry on any physical activity without discomfort. IV They should be at complete rest, confined to bed and chair Management: Drug therapy is initiated for class II or higher: 1- Mild diuretic: for class II 2- Vasodilators 3- A cardioactive glycoside may be needed especially for Class III & IV cases (under strict medical supervision).  Phytotherapy of Congestive Heart Failure Phytotherapy is the cornerstone of heart failure treatment as the first line drugs of heart failure is digoxin a plant derivative. 1. Herbs containing cardiotonic glycosides Several herbal medicines contain potent cardioactive glycoside e.g. Digitalis species leaves, Strophanthus species, Squill bulbs which have positive inotropic actions on the heart muscles and thus are potentially useful for the treatment of CHF. Cardiac glycosides increase calcium concentration in the cardiac muscle, thereby increasing contraction of the atrial and ventricular myocardium (positive inotropic action). Cardiac glycosides have a low therapeutic index, and hence, the use must be carefully controlled and used only by prescription in individualized doses i.e. conventional therapies.  Congestive Heart Failure (CHF) Cardiotonic and diuretic based phytotherapy is essential in the treatment of congestive heart failure. 2- Hawthorn Leaves & Flowers or Fruits (berries): (Crataegus laevigata) One very important plant with high potential in phytotherapy and tinctures in homeopathy is Hawthorn (Crataegus species). The activity of hawthorn is attributed to flavonoids : anthocyanidins and Proanthocyanidins. Hawthorn is devoid of serious adverse effects yet gastrointestinal complaints, palpitations, headache and flushing may occur. In comparison with the inotropic drug digoxin, hawthorn has a reduced arrhythmogenic. risk.  Hawthorn Cardiac improvement is mainly due to inhibition of cyclic AMP phosphodiesterase which leads to a positive inotropic effect. It has antioxidant activity, inotropic effect, dilates coronary blood vessels, reduces serum cholesterol and triglyceride levels (antihyperlipidemic)and has a hypotensive action due to peripheral dilation of blood vessels. It used in early stages of CHF (1&2) and as adjunct therapy for CHF (3&4), in combination with cardiac glycosides. Clinical Studies showed that Hawthorn is mainly effective on two types of cardiac patients: Chronic Heart Disease : It has the ability to improve the pumping capacity of the heart & reduce chances to angina attacks Class-2 CHF: (It is used for declining cardiac performance consistent with stage II failure) It lowered blood pressure and heart rate. Decreased physical limitation (less fatigue and shortness of breath under exercise).  Atherosclerosis Etiology It is a condition where the arteries become narrowed and hardened due to an excessive build-up of plaque of fatty deposits around the artery wall. The disease disrupts the flow of blood around body Symptoms and Causes Chest pain, cold sweats, dizziness, extreme tiredness, heart palpitations (feeling that your heart is racing), shortness of breath, nausea and weakness. Pain, aching, heaviness, or cramping in the legs when walking or climbing stairs are the main symptoms of peripheral artery disease symptoms also go away after rest. Risk factors may include high cholesterol and triglyceride levels, high blood pressure, smoking, diabetes, obesity, lack of physical activity.  Phytotherapy of Atherosclerosis 1. Garlic bulb (bulb of Allium sativa, Fam. Liliaceae) The activity of Garlic is attributed to Alliin (odorless), the enzyme Alliinase and S-allyl- cysteine. Alliinase acts on Alliin, producing Allicin which decomposes into active ajoenes and several alkyl disulfides.  Mode of action: Antithrombotic (fibrinolytic & inhibits platelet aggregation) (ajoene). Antihypercholesterolemic & antihyperlipidemic (inhibits LDL-cholesterol oxidation and increases HDL cholesterol) due to S-allyl-cysteine. It has also a vasodilator effect. Side Effects: G.I.T upset from fresh garlic and garlic odor in breath (from fresh garlic). Caution: Patients on anticoagulant. Patients on NSAIDs may have increased risk of bleeding tendency. ✓ It's used as adjunct in hypertension treatment and as a preventive measure in cardiovascular in risk patients.  2- Green Tea Extract It is extract of leaves of Thea sinensis, standardized as to the polyphenols content ( 60- 80% polyphenols). The polyphenol content will be mainly; Procyanidins (oligomers of catechins) & catechins (epigallocatechins, epicatechins & their gallate esters). Action & Uses: Potent antioxidant thus inhibits oxidation of LDL- cholesterol & formation of atherosclerosis. Useful for chemoprevention of cancer (acting as scavengers of free radicals) & cardiovascular disease.  3- Grape Seed Extract (GSE) It is standardized as to procyanidin content (90-97% polyphenols). Procyanidins are (oligomers of catechin & epicatechin). Actions & Uses: It has a potent antioxidant activity (free radical scavenger &inhibits lipid peroxidation) Potent antioxidant thus inhibits oxidation of LDL- cholesterol. Inhibit atheromatous plaque formation & atherosclerosis. Useful for chemoprevention of cancer & cardiovascular disease (acting as scavengers of free radicals). To treat certain circulatory disorders e.g., venous insufficiency.  Angina Etiology: is a radiating chest pain associated with a temporary decrease in the delivery of coronary blood to the heart muscle. (your heart muscle doesn't get enough oxygen-rich blood). (Coronary arteries supply oxygen-rich blood to the entire heart muscle) Angina may result from a variety of causes: Increased physical demands on the heart which cannot be met by the coronary oxygenation. Hypertension (which increases extensively the oxygen demands of the heart) Aortic stenosis (a narrowing of the aortic valve) & atherosclerosis (Coronary arteries become narrowed by fatty deposits plaques).  Phytotherapy of Angina 1. Hawthorn: Crataegus laevigata The key herb for the treatment of angina is Hawthorn (Crataegus spp). Hawthorn dilates coronary blood vessels, reduces myocardial oxygen demand and thus reduces symptoms of angina. 2. Ginseng: (Panax ginseng) It contains ginsenosides, saponins, sesquiterpenie and other active components. Action & Uses: Ginseng is considered a calcium-ion channel antagonist in vascular tissue. It dilates coronary arteries, inhibits atherogenesis and enhances fibrinolytic activity in the blood. The vasodilatatory effect of ginseng could be due to the release of nitric oxide. a potent vasorelaxant compound. 3. Danshen (Salvia miltiorrhiza or Red sage) Salvia miltiorrhiza or Red sage (Danshen) dilates coronary arteries and therefore may be useful in the treatment of angina. Danshen has also a protective action on ischemic myocardium. It protects myocyte from lipid peroxidation because of its free radical scavenging effects. In vitro danshen inhibits platelet aggregation decoction of the roots seems as efficacious as the isolated active principles known as tanshinones (diterpene compounds). Concomitant use of danshen and warfarin increases the anticoagulant effects of warfarin. However further studies will be necessary to evaluate the efficacy and safety of this drug. Thank you