Cardiovascular

system
 Peripheral and cerebral insufficiency
Ginkgo leaves Lesser periwinkle

1 Ginkgo leaves ( Ginkgo biloba )

Standardized ginkgo extract
• USP 31 (Ginkgo). The dried leaf of Ginkgo biloba
(Ginkgoaceae) containing not less than 0.5% of
flavonoids, calculated as flavonol glycosides, with a
mean molecular mass of 756.7, and not less than
0.1% of terpene lactones, both on the dried basis.
The leaf is khaki green to greenish-brown. Protect
from light and moisture.
• Ginkgo Biloba is a 50:1 leaf extract standardized to 24%
ginkgoflavonglycosides and a minimum of 6% terpene lactones.
• the ratio 50:1, that means 50 grams of ginkgo biloba leaves is equivalent to
1 gram of standardized ginkgo biloba extract.
Constituents:
1- Flavonoids
- Kaempferol, quercetin, isorhamnetin
- myricetin, 3- methylmyricetin
- biflavonoids, catechins and
proanthocyanidins
2- Diterpene lactones
• Ginkgolides A, B, C, J and M
3- Sesquiterpene lactone
• Bilobalide
Mechanism of actions:
1 increases blood flow,
2 increases tissue oxygenation and nutrition,
3 Prevention of membrane damage caused
by free radicals.
4 Enhances memory and cognitive function,
especially in the elderly. 5- Has platelet-activating factor (PAF)
antagonism;
The PAF antagonism: Platelet -activating factor (PAF) is an ether-linked
phospholipid which is formed by platelets, basophils, neutrophils, monocytes
and macrophages. It is a potent platelet-aggregating agent and inducer of
systemic anaphylactic symptoms.
The ginkgolides are potent and specific PAF antagonists.

Indications:
1-Disorders and symptoms due to restricted cerebral blood flow (memory
impairment, dizziness, tinnitus, anxiety /depression, fatigue and stroke).
2-Early stages of primary degenerative dementia (Alzheimer-type)
3- Effects of high altitude (altitude sickness) or hypoxia.
4- Disorders due to reduced retinal blood flow, senile macular degeneration.
5- Inner ear disorders of vascular origin: tinnitus and vertigo
6-Peripheral arterial disease (particularly intermittent claudication).
7-May also be used for disorders due to restricted peripheral blood flow
(including diabetic vascular disease, atherosclerosis, Raynaud's syndrome);
8-Osteoarthritis.
9-protection against ischemia and reperfusion injury.
10- Powerful antioxidant;
Dosage: Usually the daily dose is 120 mg of a ginkgo standardized extract
equivalent to 27-30 mg ginkgo flavone glycosides and about 10 mg terpenoids
per day (this corresponds to 4-8 g of leaf, depending on the quality).
Proprietary names: Ginko®, Tanakan®, Tebonina forte®, Brain Power®,
Ginkor fort®.
Adverse Effects: include headaches, dizziness, palpitations, gastrointestinal
disturbances, bleeding disorders, and skin hypersensitivity reactions.
Poisoning: convulsions induced by ingestion of large amounts of ginkgo
seeds. Convulsions were thought to be due to the presence of 4-
methoxypyridoxine, a competitive antagonist of pyridoxine; giving suitable
quantities of a vitamin-B6 source may be of benefit in preventing such
convulsions.
Interactions: It has been suggested that ginkgo biloba should be used with
caution in patients receiving anticoagulants or drugs that affect platelet
aggregation. For reference to a possible interaction with warfarin.
2 Lesser periwinkle (Vinca minor )

Constituents:
Alkaloids: Vincamine (the principle
alkaloid), vincine, vincaminine, vincinine
and vincanorine.
Vincamine
Mechanism of actions:
1-Vincamine is claimed to increase cerebral
circulation and utilization of oxygen 2- The total
alkaloids of Vinca minor show a pornounced
hypotensive effect.
Indications:
1- Disorders and symptoms due to restricted cerebral blood flow.
2- Age related troubles, such as memory troubles, concentration disorders,
attention and awareness disorders;
3- Degenerative trophic diseases e.g. diabetes, and atherosclerosis;
4- After acute cerebral accidents e.g. post-traumatic, post-apoplectic and
hypertensive encephalopathy.
5- Dizziness, vertigo, vascular headache and migraine;
6- Hearing and Visual troubles of vascular origin;
7- Psychiatric disorders e.g. space-time orientation and emotional
disturbances
8- To improve the intellectual capacity in children and adolescents.
Dosage:
• Crude drug: 3.0 g /day orally.
• Vincamine has been given by mouth in doses of 40 to 80 mg daily and has
also been administered intramuscularly and by intravenous infusion.
• Children: 5 mg three times daily. Adults: 10-20 mg three times daily
Proprietary names:Oxybral®, Depovinc®.
Vinpocetine is a derivative of vincamine (above) that has been given orally in
cerebrovascular disorders and dementia.
Good evidence to support its use in cognitive impairment is lacking.
 Essential hypertension
Treatment:
a) Diet and lifestyle
b) Herbal drugs
1- Rauwolfia 2-Mistletoe 3-Valerian 4-Olive leaves
5-Coleus forskohlii 6-Cramp bark 7-Yarrow 8-dandelion leaves

1 Rauwolfia ( Rauwolfia serpentina )

USP 31: The dried roots of Rauwolfia serpentina

(Apocynaceae). It contains not less than 0.15% of
reserpine-rescinnamine group alkaloids calculated as
reserpine. Store at 15° to 30° in a dry place.
Constituents: Alkaloids, the most important are reserpine (antihypertensive)
and ajmaline (anti-arrhythmic).

Reserpine
Mechanism of Action
• Reserpine irreversibly blocks the vesicular
monoamine transporter (VMAT).
• This normally transports free norepinephrine,
serotonin, and dopamine from the cytoplasm
of the presynaptic nerve terminal into
storage vesicles for subsequent release into
the synaptic cleft (exocytosis) .
• Unprotected neurotransmitters are
metabolized by MAO as well as by COMT in the cytoplasm and consequently
never reach the synapse.
• It may take the body days to weeks to replenish the depleted VMAT, so
reserpine's effects are long-lasting.
Indication:
1- Anti-hypertensive
• Dosage: Whole extract: 2mg, given once a day to begin with
and several times daily later.
• Pure alkaloid reserpine: initial 0.2 -0.3 mg is given three times
daily to begin with, 0.1- 0.2 mg twice daily for maintenance.
2- As a tranquillizers for ttt of chronic psychoses in daily doses
of up to 1 mg.

2 Mistletoe ( Viscum album )

it is semi-parasite plant, It occurs as a mixture of broken
stems and leaves and occasional fruits ?.
Constituents:
• These are alkaloids, viscotoxins (cause hypotension, acetylcholine agonists),
and lectins. All of Three classes are cytotoxic compounds.
Action and uses:
1 Mild anti-hypertensive drug. Choline derivatives are known to effect
parasympathetic stimulation and vasodilation.
2 preparations have been given by injection in a number of neoplastic
diseases.
Blood pressure tea:
• mistletoe for its gentle hypotensive effect, hawthorn to improve coronary
circulation, and melissa as a heart sedative:
• Mistletoe herb, Hawthorn leaves and flowers and Melissa leave equal parts
to make 100.0
• One cup morning and night prepared by infusing of 2 teaspoons of the
mixture for 5 -10 minutes taken in sips while still warm.
• Antihypertonicum S Schuck, Ger.
• Betula ; crataegus ; mistletoe; olive; rhododendron leaf; rutoside;
proxyphylline.
• Atherosclerosis; hypertension.
• Cefalektin Cefak, Ger.
• Mistletoe.
• Malignant neoplasms.

3-Valerian (Valeriana):

 whether this drug acts asa peripheral or central vasodilator or if the activity is due to a general
calmingeffect on the nervous systemisnot known.
 It isusually prescribed for stressed patients.

4-Olive leaves (Olea europaea ):

 Has been proven to lower high blood pressure in clinical trials provided the dose is sufficiently
high.
 Constituents: Choline-type substancesand glycoside, oleoside.

5-Coleus forskohlii:
 canhave a pronounced lowering effect on highblood pressure. Only varieties containing forskolin
should be used.
 Coleus alsohaspronounced antiplatelet activity, which maybe desirable in some cases.

6-Cramp bark ( Viburnum opulus ):

 this herb is thought to relax smooth muscle and has been used to
augment antihypertensive prescriptions as avasorelaxant.

7-Yarrow ( Achillea millefolium ):

 is usedbysomeherbalists to specifically; lower an elevated diastolic

blood pressure.

8-Taraxacum officinale (dandelion leaves)

 has diuretic activity and high levels of potassium and can be useful especially for the
treatment of elevated systolic pressure in the elderly.

Crataegus(hawthorn):
 aswell asreducing high blood pressure this herb hasa trophic effect on the heartmuscle.
 Thisis important becauseleft ventricular heart failure is often causedby
prolonged hypertension, Theleavesare apparently more potent thanthe berries
for reducing high bloodpressure.
Allium sativum (garlic):
 aswell asconfirmed antihypertensive effects this plant also favorably influences other,
cardiovascular risk factors.
 Allicin-releasing preparations are most proven in blood pressuremanagement.
 Angina
Treatment:
• a) Diet and lifestyle
• b) Herbal drugs

1 Hawthorn Berry

• Ph. Eur. 6.2 (Hawthorn Berries). The dried false fruits of Crataegus
oxyacantha (C. laevigata), or C. monogyna, or their hybrids or a mixture of
these false fruits. They contain not less than 1% of procyanidins, calculated
as cyaniding chloride with reference to the dried drug. Protect from light.
• Ph. Eur. 6.2 (Hawthorn Leaf and Flower). The whole or cut, dried flower
bearing branches of Crataegus oxyacantha (C. laevigata), or C. monogyna, or
their hybrids or, more rarely, other European Crataegus species including C.
pentagyna, C. nigra, and C. azarolus. It contains not less than 1.5% of
flavonoids, calculated as hyperoside calculated with reference to the dried
drug. Protect from light.
Constituents:
- Flavonoids ( including hyperoside , rutin , and vitexin) and oligomeric
proanthocyanidins (largely responsible for action of drug).
- Biogenic amines (such as tyramine)(some of cardiotonic action)
- Triterpenes

Mechanism of action;
- Inhibition of phosphodiesterase activity in tissue with a subsequent
inhibition of cAMP is believed to be the mechanism of action.
- Hawthorn does not have a digitalis-like effect, but the drug have a
completely different site of action in the myocardium. Hawthorn does
not exert its action in the contractile system of the myocardium, but
improves the myocardial energy metabolism. This probably explains
why hawthorn requires a much Longer time than digitalis to take effect
 and why myocardial reactivity must exist in order for the herbal drug to
take effect.
- Hawthorn's biological profile of action summarized as follows:
1- Hawthorn increases coronary and myocardial circulation.
2- Hawthorn improves myocardial contractility (slightly positive inotropic).
3- It has a eurhythmic effect on certain types of electrical heart instabilities.
4- Hawthorn increases myocardial tolerance to oxygen deficiency.
5- Hawthorn increases cardiac output, reduces peripheral resistance
(a parameter of after- load), and increases cardiac performance.
Indication:
- Cardiotonic (mild), cardioprotective, hypotensive, antiarrhythmic. i.e.
increases force of myocardial contraction, increases coronary blood flow,
reduces myocardial oxygen demand, protects against myocardial damage,
improves heart rate variability. Can be used for congestive heart disease due
to ischemia or hypertension; cardiac insufficiency.
- Reduction of cholesterol.
- Stabilization of connective tissue tone (collagen stabilizing);
- Antioxidant activity; co-factor for vitamin C intake;
Interactions:
Hawthorn may act in synergy with digitalis glycosides, beta-blockers and other
hypotensive drugs. Modification of drug dosage may be required.
Dosage:
a) 1.5 - 3.5 g of dried berry, flower or leaf per day, as infusion or decoction.
b) Hawthorn tablets (1 g leaves and flowers, standardized to 15-20 mg
oligomeric procyanidins and 6-7 mg flavonoids) 2-3 times per day.
c) 3 - 6 ml of 1: 2 liquid extract of hawthorn leaf per day, 3 - 7 ml of 1: 2 liquid
extract of hawthorn berry per day,
7.5 - 15 ml of 1: 5 tincture of hawthorn leaf per day,
7.5 - 17.5 ml of 1: 5 tincture of hawthorn berry per day.
Higher doses than these may be necessary for effective control of hypertension.
- There is no restriction on the long-term use of hawthorn and, if used to treat
heart conditions, it should be prescribed over a period of at least 2 months.
2 Garlic (Allium sativum)
Constituents:
Alliin, allicin, S-propylcysteinesulfoxide and 5-methylcysteine-
sulfoxide.
Action and uses:
Garlic (Allium sativum) has Protective effects against stroke, coronary
thrombosis, atherosclerosis, platelet aggregation.
- Antibacterial, antifungal, antiviral, antioxidant, antineoplastic,
hypolipidemic, antiarthritic actions and hypoglycemic functions.
- General tonic effect thought stimulation of hypophyseal function.
Dosage:
Bulb: 10 - 25 g;
Alliin: 10 mg;
Allicin: 4 mg.
Preparations:
1 Carefully dried garlic powder which preserves the compound alliin (S-
allylcysteine sulphoxide) and the enzyme alliinase. On disintegration of
tablets or capsules containing this powder in the digestive tract, alliin comes
into contact with alliinase and is converted to allicin.
2 Aged garlic extracts or 'odorless' garlic products which are produced by a
fermentation process. These preparations contain modified sulfur
compounds such as S-allylcysteine.
3 Steam-distilled preparations of garlic (garlic oil) which are rich in
diallylsulfides.

3 Arnica (Arnica montana)

Constituent
- Sesquiterpene lactones helenalin dihydrohelenalin and their esters).
- Flavonoids
Indications:
 Arnica may be used on the same indications as the hawthorn-
senile hearts and coronary artery disease with or without angina.
 There are, distinct differences between the two;
-Arnica has rapid stimulant action, is generally given more to treat acute short-
term weakness of the heart.
-Hawthorn, is predominantly used in the long-term treatment of coronary
artery disease.

4-Salvia miltiorrhiza (dan shen)

- is a Chinese herb, which has been clinically studied for angina and other heart
conditions.
-Its benefits include cardioprotective, vasodilator and anti-platelet activities.
5-Grape seed extract (100 mg/day)
-can provide a suitable in reducing heart disease.
6-Capsicum spp.
- (cayenne) has fibrinolytic activity and was traditionally used to improve
myocardial blood supply.
7-Anti-platelet herbs
-such as Coleus forskohlii. Allium sativum (garlic), Zingiber (ginger) and Curcuma
longa (turmeric) may have value even if the patient is taking aspirin.
-They also have other properties which may be beneficial; e.g. coleus is a
vasodilator and curcuma is antioxidant However, care should be taken to
ensure that bleeding time is not excessively prolonged.
8-Other vasodilating and relaxing herbs
-which are prescribed include Tilia species (lime flowers) and Viburnum opulus
(cramp bark).
 Hyperlipidemia

1 Gymnema (Gymnema sylvestre)

‫الغورمار باركستا أو حارق السكر‬
Constituents:
• Saponins (Gymnemic Acids), alkaloids, flavones and
anthraquinones.
Action and uses:
• Saponins have been reported to
- Decrease plasma-cholesterol levels.
- Decrease blood glucose levels.
- Antiobesity.
Mechanism of actions:
• Saponins decrease intestinal absorption of cholesterol and glucose and
increases insulin secretion in human β-cells. It has anti-sweetness (which
decrease the appetite
Dosage:
• - 200-400 mg of extract taken by mouth twice daily
• - 2 ml of an aqueous decoction (10 grams of shade-dried powdered leaves
per 100 milliliters) three times daily have been studied.

2 Statins (HMG-CoA reductase inhibitors):

• Inhibiting cholesterol synthesis
• Increasing LDL uptake: draw cholesterol out of the circulation.
1- Lovastatin
It was isolated in the 1970s in the broths of Monascus ruber (red yeast rice),
Aspergillus terreus and Pleurotus ostreatus (oyster mashroom). Lovastatin, the
first commercially marketed statin, was approved by the FDA in 1987.
 Varicose veins
Causes
• Weakness of the vein wall and
poor venous tone can lead to
venous valves becoming
incompetent.
1 Horse-chestnut seed
(Aesculus hippocastanum)
‫كستناء الحصان‬
Constituents:
• Saponins (3- 6%) (the mixture of saponins collectively referred
to as escin; α- and b-escin as major glycosides), Coumarins,
flavonoids and tannins.
Action and uses:
-It can be used for chronic venous insufficiency, varicose veins, edema of the
lower limbs.
- It is used as prophylactic to decrease the incidence of deep venous
thrombosis following surgery.
- Topically for hematoma, contusions, non-penetrating wounds and injuries
involving edema.
-Skin care products: for normal skin, baby skin, sensitive skin; to tone the skin;
as an anti- inflammatory; to treat fragile capillaries, pimples, sunburn or
cellulite.
Mechanism of actions:
• (Increases venous tone, increases capillary resistance, decreases capillary
permeability, improves circulation by toning veins; decreases edema from
lymphatic congestion or of inflammatory origin, i.e. venotonic, anti-
edematous, anti-inflammatory)
Dosage:
• Dried seed: 1 - 2 g per day.
• Horse-chestnut tablets (200 mg of 5 : 1 concentrated extract, standardized
to contain 40 mg escin): 2-3 tablets per day.
Proprietary names:
• Reparil® Tablets, Reparil® gel, Escinogel® gel, Prostatin® suppositories

2 Melilot (Melilotus officinalis)

‫الطب أو إكليل الملك‬
‫ي‬ ‫الحندقوق‬
Constituents:
• Melilot contains coumarin and flavones.
Action and uses:
• Internally in the treatment of varicose veins and thrombophlebitis.
Preparations:
• Melilot tea, 1-2 teaspoons to a cup of boiling water, left to infuse, taking 3-4
cups daily.

3 Flavonoids as Polyphenolic compounds e.g. anthocyanins and

maintaining healthy circulation.
• Anthocyanins could also reduce the incidences of fragility of capillaries,
inhibit blood platelet aggregation, and strengthen the collagen matrix
which is a component of the connective tissues.
• These polyphenolics such as anthocyanins and flavonoids might also act as
the beneficial in vivo inhibitors of LDL oxidation.
• In fact, the “French paradox” which represents the
apparent compatibility of a high fat diet with a low
incidence of coronary atherosclerosis has daily been
attributed to the regular drinking of the red wines.
• ex. bilberry and grape seeds extract.
4 Rue (Ruta graveolens)
‫سذاب شديد الرائحة‬
Constituents and uses:
• It contains rutin, considered to be a compound with vitamin P activity.
Preparations:
• Ruta C tablets® and Rutin C tablets® contain 50 mg of rutin (rutoside), so that
the drug is easy to prescribe.

• Cardiovascular disease of
functional origin is extremely
common nowadays.
 Functional heart disease, nervous heart

• The drugs used in these cases should have a gentle cardiotonic and sedative
action. They are therefore also known as cardiosedatives. The plant
kingdom provides a number of drugs for this purpose, all of which have
stood the test of time.
• Motherwort and convallaria (Lily of the valley) are gentle and Intermediate
cardiotonics respectively .

1 Motherwort (Leonurus cardiaca)

‫ذنب األسد‬
Constituents:
Alkaloids: leonurine Stachydrine, betonicine, and turicin ; flavonoids; iridoids;
tannins; terpenoids ... etc.
Uses:
Mainly for functional heart complaints due to autonomic imbalance. It appears
to be predominantly sedative, similar to valerian. It is necessary, however, to
take the drug for a long period, over months.

A tea combining the drug with convallaria and melissa (as a sedative) is very
useful. Motherwort herb
Lily of the valley herb Melissa leaves
equal parts to make 100.0
Infuse two teaspoons in a cup of boiling water, 1 cup to be taken regularly
morning and night for some weeks.

2 Lily of the valley (Convallaria majalis)

‫زنبق الوادي‬
Constituents:
Cardiac glycoside: Convallamarin and Convallarin convallatoxin ,
trace of volatile oil, tannin
Uses:
cardiac tonic and diuretic.
Mechanism of actions:
The action of the drug closely resembles that of Digitalis, though it is less
powerful
Dose
The infusion of 3 teaspoonful of herb to 2 cup of boiling water is also taken in
tablespoonful doses

3 Digoxin
A cardiotonic glycoside obtained from the leaves of Digitalis lanata
(Scrophulariaceae).

Digoxin in Pharmacopoeias.
• Ph. Eur. 6.2 (Digoxin). A white or almost white powder or colourless crystals.
Practically insoluble in water; slightly soluble in alcohol; freely soluble in a
mixture of equal volumes of dichloromethane and methyl alcohol. Protect
from light.

• USP 31 (Digoxin). A cardiotonic glycoside obtained from theleaves of

Digitalis lanata (Scrophulariaceae). Clear to white, odourless, crystals, or a
white, odourless, crystalline powder. Practically insoluble in water and in
ether; slightly soluble in diluted alcohol and in chloroform; freely soluble in
pyridine. Store in airtight containers.

Uses:
Digoxin is a cardiac glycoside used in the management of
1 supraventricular arrhythmias, particularly atrial fibrillation and
2 in heart failure .
Pharmacology
The principal actions of digoxin are
1 an increase in the force of myocardial contraction (positive inotropic
activity) ,
2 decrease heart rate (negative chronotropic effects ) and 3- decreased AV
nodal activity(negative dromotropy).
1-By inhibiting the Na+/K+-ATPase, cause increase intracellular sodium
concentration, which leads to an accumulation of intracellular calcium via the
Na+- Ca++exchange system. Increased intracellular calcium.
A-In the heart, increases contractility (positive inotropic activity).
B-In vascular smooth muscle causes smooth muscle contraction and
vasoconstriction.

2-By mechanisms that are not fully understood, digoxin also increase vagal
efferent activity to the heart. This parasympathomimetic action of digoxin
(decreases heart rate; negative chronotropy) and reduces conduction velocity
of electrical impulses through the atrioventricular node (negative dromotropy).
products examples
Egypt : Lanoxin ® tab & amp and Cardixine ® tab France: Hemigoxine Nativelle
tab ® Germany : Lanicor® tab ® UK: Lanoxin ® tab & amp USA: Digitek ® tab.