CVS
Disorder
Congestive Heart Failure (CHF) Atherosclerosis Angina
Gradual reduction in heart functions, i.e., the heart is
Condition where the arteries become narrowed and hardened due to excessive buildup of
unable to supply blood to all body organs:
plaque of fatty deposits (e.g., LDL) around the artery wall: Radiating chest pain associated with temporary decrease in the
Etiology Decrease in Inotropic activity.
Cholesterol Oxidation → Uptake & Deposition in artery delivery of coronary blood to the heart muscle.
Decrease in cardiac output.
Disrupt Blood Flow around the body.
Generalized Edema of body.
Hawthorn Danshen
Herbs Containing Hawthorn Garlic bulb Green Tea Ginseng
Phytotherapy Grape Seed Extract Crataegus Salvia miltiorrhiza
Cardiotonic Glycosides (Crataegus laevigata) (Allium sativa) (Thea sinensis) (Panax ginseng)
laevigata {Red Sage}
Flavonoids
Polyphenols Tanshinones
(60 – 80%): Polyphenols Ginsenosides
(Diterpene
Flavonoids: ➔ Procyanidins (90 – 97%): Saponins
Active Compounds)
Constituents
➔ Anthocyanidins Ajoenes (Oligomers of Catechins) ➔ Procyanidins Sesquiterpene
➔ Catechins {Hydrophobic
➔ Proanthocyanidins (Oligomers of Catechins & (rich in volatile
(Epigallocatechins) Epicatechin)
property zy el fel
oils)
(Epicatechins) volatile oils}
(Gallate Esters)
Positive Inotropic Dilates Coronary
Ca2+ channel
Action: Artery
Antagonist:
➔ Inhibition of cAMP
➔ Heart
phosphodiesterase.
Antithrombotic Dilates Contraction by Protective Action on
Antioxidant: Potent Antioxidant: Coronary Ca2+. Ischemic
Positive Inotropic ➔ Free Radical Fibrinolytic
➔ Inhibits oxidation of Blood vessels. Myocardium
Inhibit Platelet Dilates Coronary
Mechanism of Action
Action: scavenger. Potent Antioxidant: LDL-C
➔ Increase Ca conc. in
2+
Aggregation Artery:
Dilates Coronary ➔ Inhibits oxidation of ➔ Free Radical Myocardial ➔ Release of Nitric Protect Myocyte
cardiac muscle →
blood vessels: Antihypercholesterolemic LDL-C Scavenger Oxygen from Lipid
Increasing & Oxide
➔ Blood flow to Heart. ➔ Free Radical ➔ Inhibit Lipid Demand Peroxidation:
contraction of the Antihyperlipidemic: Inhibits
Antihyperlipidemic: Scavenging Peroxidation ➔ Free Radical
atrial & ventricular ➔ Inhibit LDL-C Atherogenesis
➔ Cholesterol levels Inhibit Atheromatous Reduces scavenger.
myocardium. ➔ Increase HDL-C
➔ Triglyceride levels plaque formation Symptoms of ➔ Prevent LDL
Vasodilator Effect Fibrinolytic
Hypotensive Action: Angina Oxidation
➔ Peripheral Inhibits Platelets
Inhibit Platelet Aggregation
Vasodilation
Aggregation
(In Vitro)
Low therapeutic index: Increases
➔ Arrhythmogenic risk Increased Risk of Bleeding: Anticoagulant effect
➔ Used ONLY by ➔ Patients with Anticoagulants of Warfarin:
Caution
prescription. (e.g., Warfarin) ➔ Patients on
➔ Used in Individualized ➔ Patients on NSAIDs concomitant use of
DOSE. Danshen and warfarin
Devoid of
Wide Therapeutic Index:
GIT Upset (Fresh Garlic) Serious ADRs
Advantages “SAFE”
GI Complaints
& { +ve Inotropic bs 22al Garlic Odor in Breath
Palpitations
Side Effects mn el Digoxin} (Fresh Garlic) Headache
➔ Arrhythmogenic Risk
Flushing
Monotherapy @ CHF
Chemoprevention for
Class 1&2 Adjunct in Hypertension
Cancer.
Chemoprevention for
[Free Radical
Use(s) Adjunct Therapy @ Preventive Measure in Cancer.
Scavenger]
CHF Class 3&4: cardiovascular in risk [Free Radical Scavenger]
Venous Insufficiency
+ Cardiac Glycosides patients.
(Circulatory Disorder)
(Digoxin)+ Diuretic
1. Give reason: Herbal products have a wide range of biological activities?
- Each herbal product has MANY ACTIVE CONSTITUENTS.
2. Give Reason: Phytotherapy is the cornerstone of heart failure treatment?
- The first line drug of heart failure is digoxin a plant derivative.
3. True or False: Cardiotonic & Diuretic based phytotherapy is essential in treatment
of CHF.
- True.
4. What part of Hawthorn plant is used to treat CHF?
- Ariel Parts: Outer parts (Leaves – Fruits – Flower)
5. True or False: Flavonoids (Anthocyanidins & Proanthocyanidins) are
responsible for the plant color.
- True.
6. Give some examples for Herbs containing Cardiac Glycosides?
- Digitalis species leaves
- Strophanthus species
- Squill bulbs
7. Clinical Studies showed that Hawthorn is mainly effective on tow types of
cardiac patients. Whom are these patients?
- Patients with Chronic Heart Disease
- Patients with Class-2 CHF
8. Give Reason: Hawthorn is effective for patients with Chronic Heart Disease?
- Hawthorn has the ability to improve the pumping capacity of the heart and reduce chances to
Angina Attacks.
9. Give Reason: Hawthorn is effective for patients with Class-2 CHF?
- Hawthorn lowers blood pressure and heart rate; in addition, it is able to Decrease physical
limitation (i.e., Less fatigue and shortness of breath under exercise.)
10. True or False: Free radicals are one of the main reasons for Atherosclerosis
formation.
- True.
11. Give Reason: The activity of Garlic is attributed to Alliin (odorless) and the
enzyme Alliinase?
- Alliin Alliinase Allicin Ajoenes + Alkyl Disulfides
12. The Key herb for the treatment of angina is Hawthorn (Crataegus spp.)
13. Define Athergenesis?
- Process of arthymateous plaque formation in the artery.
By: Fady Wagih
Thank U
