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Cardiovascular Drugs during Pregnancy
Published in “Bert” Bertis Britt Little, Drugs and Pregnancy, 2022
Ajmaline is a potent sodium blocker. Its use in pregnancy has only been published only in case reports for acute treatment of tachyarrhythmias, VT, and SVT. It is recommended that lidocaine or procainamide be used for longer-term treatment because they are better studied for use during pregnancy (Merino and Perez-Silva, 2011).
Plantago ovata (Isabgol) and Rauvolfia serpentina (Indian Snakeroot)
Published in Azamal Husen, Herbs, Shrubs, and Trees of Potential Medicinal Benefits, 2022
Ankur Anavkar, Nimisha Patel, Ahmad Ali, Hina Alim
Reserpine is the one of the most used alkaloids and has several therapeutic applications. Over the years, it has been useful in the treatment of hypertension, cardiovascular diseases, and neurological diseases. Reserpine acts as a hypotensive agent by depleting the catecholamine. Angiotensin-converting enzyme (ACE) is inhibited by rescinnamine (Figure 13.4G) to halt the conversion of angiotensin I, resulting in a decrease of plasma angiotensin II, and then lowering the blood pressure. Thus, both reserpine and rescinnamine act as hypotensive agents (Bunkar, 2017; Malviya and Sason, 2016; Shah et al., 2020). Other alkaloids also have a major role to play in various therapeutic activities of R. serpentina. Ajmaline (Figure 13.4A) is used as a class 1 anti-arrhythmic and useful in diagnosing a hereditary cardiac disorder known as Bruguda syndrome. Ajmalicine (Figure 13.4C) is useful in treatment of circulatory diseases, while serpentine (Figure 13.4J) has antipsychotic properties. Deserpidine (Figure 13.4D) has both hypotensive and antipsychotic behavior; and Yohimbine (Figure 13.4L), being an alpha-adrenergic antagonist, helps to treat erectile dysfunction (Kumari et al., 2013).
Syncope Management and Diagnostic Testing
Published in Andrea Natale, Oussama M. Wazni, Kalyanam Shivkumar, Francis E. Marchlinski, Handbook of Cardiac Electrophysiology, 2020
Subramanya Prasad, Oussama M. Wazni, Robert Schweikert, Kenneth Mayuga, Mina K. Chung
The minimum testing required during an EPS for syncope diagnosis per ESC guidelines is: Measurement of sinus node recovery time and corrected sinus node recovery time by repeated sequences of atrial pacing for 30–60 s with at least one low (10–20 beats/min higher than sinus rate) and two higher pacing rates.Assessment of the His Purkinje system includes measurement of the HV interval at baseline and His Purkinje conduction with stress by incremental atrial pacing. If the baseline study is inconclusive, pharmacologic provocation with slow infusion of ajmaline (1 mg/kg iv), procainamide (10 mg/kg iv), or disopyramide (2 mg/kg iv) is added unless contraindicated.Assessment of ventricular arrhythmia inducibility by ventricular program-med stimulation at two right ventricular sites (apex and outflow tract), at two basic drive cycle lengths (100 or 120 beats/min), with up to 2 extra stimuli. Use of a third extra stimulus can increase sensitivity but decreases specificity.Assessment of supraventricular arrhythmia inducibility by any atrial stimulation protocol.
Brugada syndrome clinical update
Published in Hospital Practice, 2021
Rhadames Rojas, Risheek Kaul, Daniel Frenkel, Ethan G Hoch, Sei Iwai, Jason T Jacobson, Wilbert S. Aronow
Frequently, variations in the EKG pattern can occur in a patient including complete absence of the BrS pattern. Repositioning the right precordial leads from the traditional location in the 4th intercostal space to more a cranial position in the 2nd or 3rd intercostal space may increase the ability to detect Brugada pattern EKG given its proximity to the right ventricular outflow tract (RVOT) [14]. Sodium channel blocking drugs (such as those listed in Table 1) can also be used to unmask the Type 1 EKG pattern and establish the diagnosis [15,16]. During a drug challenge, continuous EKG monitoring along with full resuscitative equipment is necessary for every test. The drug challenge must be stopped when the diagnosis has been established, or alternatively if there is prolongation of the QRS width to 130% of baseline, or presence of frequent premature ventricular stimuli. The drug challenge is typically performed when there is a clinical suspicion for the disease based on the patient’s history and presentation. Drug-induced tests can have false negatives 14–32% of the time especially when using procainamide and flecainide [1,17,18]. If the history is highly suggestive, a repeat test using intravenous ajmaline should be considered if available. In the United States, only intravenous procainamide is routinely available. In countries where intravenous sodium channel blockers are not available, there are limited data to support the use of oral flecainide [19].
Brugada syndrome and the story of Dave
Published in Neuropsychological Rehabilitation, 2018
Samira Kashinath Dhamapurkar, Barbara A Wilson, Anita Rose, Gerhard Florschutz
The typical patient with BrS is young, male, and otherwise healthy, with normal general medical and cardiovascular physical examinations. Consequently, a cardiac arrest may appear out of the blue. For those where BrS is suspected, such as in patients with palpitations, giddiness, recurrent fainting, nocturnal breathing with short, sporadic gasps of air, an ECG will probably be recommended together with referral to a cardiac specialist. If BrS is suspected, a simple and safe test known as the ajmaline test may be given to confirm or disconfirm the diagnosis. Ajmaline is an alkaloid that corrects abnormal heart rhythms. If given to someone with BrS it can reveal the characteristic abnormal ECG pattern. Other anti-arrhythmic medicines, such as propafenone or procainamide, can also reveal an irregular ECG result and lead to a diagnosis of BrS. (Rolf et al., 2003). Genetic testing may also be carried out to detect the faulty gene (2015 ESC guidelines for ventricular arrhythmia).
Sodium-glucose transporter (SGLT2) inhibition: A potential target for treatment of type-2 Diabetes Mellitus with Natural and Synthetic compounds
Published in Egyptian Journal of Basic and Applied Sciences, 2023
Shubham Batra, Prabhjeet Kaur Bamrah, Manjusha Choudhary
Alstonia Macrophylla is a traditional plant that grows widely in the Southeast Asia region, India, Indonesia, Thailand, and Vietnam. It is commonly known as Big-leaved macrophyllum, Hard common Alstonia, or Hard milkwood [65]. It is used in traditional medicine as a common tonic, antifever, emmenagogue, aphrodisiac, antidysentery, anticholinergic, and vulnerary agents [66]. A. macrophylla leaves were used to isolate twenty alkaloid compounds, and their ability to inhibit SGLT was evaluated. Five picraline-type alkaloids out of twenty compounds exhibited effective SGLT1 and SGLT2 inhibition. Other alkaloid compounds of the ajmaline and macroline types, however, exhibited no inhibitory effects on SGLT1 and/or SGLT2 [67].