cardiac deseases and herbs use against them

Presented By: Arslan(13893) Usman(14254) Daniyal(14681) Abdullah(14659)

Topic:Cardiac Deseases And Herbs Use Against Them

Presented to: DR. RABEEA KHAN

RIPHAH INSTITUTE OF PHARMACEUTICAL SCIENCES

PHARMACOGNOSY

CONTENTSo Hypertensiono Plants Used in Hypertension a) Rauwolfia Serpentina b) Veratrum

o Angina & Arrythmiaso Plants used in Angina & Arrythmias: a)Crataegus hawthorn b)Convallaria majalis

Congestive Heart Failureo Plants used in Congestive Heart Failure: a) Digitalis.

o Atherosclerosiso Plants used in Atherosclerosis: a) Allium sativum. b) Punica granatum.

Introduction

Cardiovascular disease (CVD) is a class of diseases that involve the heart or blood vessels. Cardiovascular disease includes coronary artery diseases (CAD) such as angina, heart arrhythmia, hypertension, peripheral and central vascular disease and myocardial infarction (heart failure).

Hypertension

Hypertension is: High Blood Pressure, a medical condition in which constricted arterial blood

vessels increase the resistance to blood flow, causing an increase in blood pressure against vessel walls.

• Simply put, as a common disorder in which blood pressure remains abnormally high.

• Affects ~50 million people in the US

Types of Hypertension• Types:

– 1. Primary• Chronic high blood pressure without a source or associated with any other disease• Most common form of hypertension

– 2. Secondary• Elevation of blood pressure associated with another disease such as kidney disease

• The organs and tissue in your body need oxygen to survive.

• Oxygen is bound to your blood and is delivered( after an exchange of carbon dioxide for oxygen in your lungs) to your body by blood vessels.

• When your heart beats, it creates pressure that pushes blood through your arteries and veins, also known as blood vessels and capillaries.

• Blood pressure is the force of blood pushing against your blood vessel walls.

• Your blood pressure must be within a normal range to properly deliver this oxygen rich blood to your organs and tissues in order to survive.

• When someone has high blood pressure , this increased force makes the heart work harder to pump blood to the body.

• The increased force puts a strain on both the heart and the blood vessels.

• If the force of the blood flow is high for some time, eventually the tissue that makes up the walls of the arteries gets stretched beyond its healthy limit.

• This overstretching of the blood vessels makes them more prone to rupture.

• Damages to the vessels results in the development of Atherosclerosis ( hardening of the arteries).

• Uncontrolled high blood pressure increases your risk of serious health problems, including heart attack and stroke

Causes• Genetics-some people are prone to hypertension simply based off of their

genetic makeup• Family History- your risk for high blood pressure/hypertension increases if it

is in your family history• Environment

– Inactivity– Stress– Obesity– Alcohol– High Sodium Diet– Tobacco Use– Age– Menopausal Medications

Further Complications of High Blood Pressure

• Thickening of the heart muscle• Increased workload of the heart• May lead to other conditions such as:– Heart attack– Stroke– Renal (Kidney) Failure– Loss of vision

• Those who have higher sensitivity to salt are at higher risk of hypertension…

So why salt is bad ?

Signs and Symptoms

• Diagnosed through repeat blood pressure readings• Primary Hypertension does not have symptoms other

than high blood pressure• Secondary Hypertension– Most likely caused by Renal Disorders, symptoms

you will see:• Decreased urine formation• Increased sodium and water retention

Plants Used In Hypertension

Rauvolfia serpentina

Common Names:Serpentine wood, chandarbagha and Indian snakeroot.Botanical Name:Rauvolfia serpentina.Part used: Dried Root. Family: Apocynaceae.Geographical regions:It is distributed in Central and South America, Africa, India, Sri Lanka, Burma, China and Japan

Chemical Constituents:Rauvolfia root contains more than 200 alkaloids. The major alkaloids are divided into two groups:Ajmaline group:

Ajmaline, Ajmalinine and Ajmalicine. Serpentine group: Serpentine and Serpentinine. Others include:Reserpine, Rescinnamine and Yohimbine,indobine, and deserpidine. The roots also contain oleoresins, a sterol, unsaturated alcohols, oleic acid, fumaric acid, glucose,

sucrose, a derivative or oxymethylantheraquinone, a strongly fluorescent substance and mineral salts

Mechanism of Action:• Reserpine was one of the first drugs used on a large scale to treat systemic hypertension. It

acts by irreversibly blocking the uptake of biogenic amines (norepinephrine, dopamine, and serotonin) in the storage vesicles of central and peripheral adrenergic neurons, thus leaving the catecholamines to be destroyed by the enzyme monoamine oxidase in the cytoplasm.

• The depletion of catecholamines accounts for reserpine's sympatholytic and antihypertensive actions.

• Reserpine's effects are long lasting, since recovery of sympathetic function requires synthesis of new storage vesicles, which takes days to weeks.

• Dose: The daily oral dose of reserpine should be 0.25 mg or less, and as little as 0.05 mg if given with a diuretic. Using the whole root, the usual adult dose is 50 to 200 mg/d administered once daily or in 2 divided doses

• Uses:• The root extract obtained is considered to be the best medicine for high

blood pressure, mental agitation, insomnia and also used as a sedative.• Extracts of R.serpentina is also helpful in curing other diseases such as

fever, malaria, eye diseases, pneumonia, asthma, headache, skin disease and spleen disorder.

• The plant extract has anti-prostate cancer activity.• Used in the treatment of cholera.• Used to treat liver pain, stomach pain and to expel intestinal worms.• Extracts of the roots are valued for the treatment of intestinal disorders,

particularly diarrhoea and dysentery and also as anathematic.

Veratrum album

Common Name: white hellebore, European white hellebore or white veratrum.Botanical Name: Veratrum album. Part Used: Roots and rhizome.Family:Melanthiaceae.Geographical distribution:Canada, Alaska, USA and AsiaChemical Constituents:Veratrum contains steroidal alkaloidsVeratralbine 0.03 jervine 0.1%Barytine.Protoveratridine 0.005%Pseudo-jervine 0.1%Rubijervine 0.005%Protoveratrine 0.1%.

Mechanism of Action:• Veratrum alkaloids enhance nerve and muscle excitability by increasing sodium ion

conductivity. • They act on the posterior wall of the left ventricle and the coronary sinus baroreceptors,

causing reflex hypotension and bradycardia via the vagus nerve (Bezold-Jarisch reflex).

Dose:• 3 x dilution may be added to water in the proportion of 30 drops of the tincture to 4

fluid ounces of water, the dose of which, in severe cases, is a teaspoonful every 15 minutes.

• For its earlier uses, the dose of the powder is from 1 to 8 grains, gradually and cautiously increased, commencing with 1 grain, from 20 to 60 minims. Its use always requires great care.

• Medicinal Uses:• In the treatment of hypertension.• In the form of decoction or ointment, as an external

application to kill lice, and cure the itch, pruritis, scabies and some other cutaneous affections.

• It has been used for the cure of gout.• It used to be employed in cholera infantum, cholera

morbus and asiatic cholera in all of which it also checks the vomiting

ANGINA PECTORISBy Muhammad Usman Sarwar

14254

Angina Pectoris• is recurring acute chest pain or discomfort resulting from decreased blood

supply to the heart muscle (myocardial ischemia).• “Increasing Demand of oxygen but the heart can’t supply”

• Generally due to obstruction or spasm of the coronary arteries.

• The chest pain comes either as a form of pressure or discomfort when blood flow is reduced, your heart does not get as much oxygen asit needs.

• This lack of oxygen is what causes the pain and discomfort of angina.• If you have coronary heart disease, angina is the way your heart tells you it

needs more oxygen

TypesAngina is consisted of three types:

• Stable

• Unstable

• Variant (Prinzmetal's Angina)

Stable Angina

• Most common type

• when the patient has greater than or equal to 70% stenosis

• Induced by physical activity (increase demand of O2), or emotional stress.• And can’t be supplied because of partially occluded coronary artery

caused by atherosclerosis)

• The pain is relieved by rest.

Causes of stable angina

• Atherosclerosis of one or more coronary arteries—arteries supplying blood to the heart muscles.

• Or thickened heart muscle wall, which would require more oxygen.– This increase in muscle size can be due to hypertrophic cardiomyopathy

from a genetic cause, or as a result from the heart having to pump against higher pressures, as is the case in aortic stenosis, which is a narrowing of the aortic valve, or hypertension. These larger, thicker heart muscles require more oxygen, and if the patients can’t meet increasing demands, they feel pain in the form of angina.

Unstable Angina

Dangerous and requires emergency treatment.Unstable angina is the rupture of the fibrous cap, leading to the blockage of the artery by clotted blood.

• Occurs with increasing frequency (progression)• Patients have pain during exercise or stress as well as

during rest—it never really goes away.• Can lead to MI.

Vasospastic Angina(prinzmetal's Angina)• Patients may or may not also have atherosclerosis.• Ischemia, and resulting chest pain is due to coronary

artery vasospasms, meaning the muscles around the arteries constrict extremely tightly and reduce blood flow enough cause ischemia.

• Episodes of vasospastic angina can happen anytime.• The underlying mechanism causing vasospasms isn’t well

understood, but most likely involves vasoconstrictors like platelet thromboxane A2.

• Coronary artery is constricted severely that all layers of the heart wall being supplied are affected, therefore it’s referred to as transmural ischemia.

Plants used in Angina :

Crataegus Hawthorn

Common Name: Hawthorne, Mayblossom, hedgethorn, maybush, mayflower.Botanical Name: Crataegus oxyacantha & C.monogynaPart Used: leaves, flowers and fruitsFamily:RosaceaeGeographical distribution:

England and other European countries such as Albania, Bulgaria, Romania, Hungary, Macedonia and Poland.

Chemical Constituents:• Hawthorn contains around 1-2% flavonoids, • Oligomeric proanthocyanidins (1-3%), • Saponins, • Phenolic acids (chlorogenic acid, caffeic acid), • 2-2-Phenylethyl chromone derivatives (in the flowers, leaves and buds) • Amine (phenethylamine, metoksyfenetylamin, dopamine, acetylcholine and tyramine) and

triterpenes based on ursolic acid and oleanolic acid.• Anthocyanin is found in the fruit peel and the fruit contains essential oil, pectin, vitamin C

and other substances.

Mechanism of Action:

• Hawthorn works by increasing stroke volume, where the amount of blood per heart beat is increased, and lowering blood pressure and pulse rate.

• The primary mechanism involves cyclic AMP (adenosine monophosphate). When stimulated, receptors on the outsides of muscle cell membrane enable the synthesis of adenylyl cyclase.

• The presence of cAMP activates the calcium channels in the muscle cell membranes. In heart muscle cells, calcium influx promotes increased heart contractility.

• When epinephrine and norepinephrine bind to membrane receptors, a chain reaction is initiated; the increased calcium level results in increased ionotropic capacity and negative chronotropic actions.

• The mechanism of cardiac action for Crataegus species is due to the inhibition of the 3‘, 5‘-cyclic adenosine monophosphate phosphodiesterase.

• Crataegus constituents act as natural angiotensin converting enzyme (ACE) inhibitors. ACE is an important enzyme involved with blood pressure regulation and also sodium and electrolyte balance in tissues. Inhibiting ACE also serves to lower blood pressure and strengthen heart muscle function.

• Crataegus inhibits ACE, presumably due to its procyanidin oligomers. When this enzyme is inhibited,

angiotensin I is not converted to angiotensin II. As a result, the production of aldosterone is reduced. Since aldosterone promotes water and sodium retention,in its absence sodium and water are more easily excreted.

• Medicinal Uses:• Crataegus has long been used as a heart tonic for both hyper- and

hypotension. • Crataegus also regulates heart rhythm in patients with heart failure.• Crataegus to improve aortic contractility in heart failure.

also be helpful in treating elevated cholesterol levels and atherosclerosis.

• Dose:160 to 1,800 mg/day standardized extracts in divided doses over 3 to 24 weeks. 900mg in CCF is also safe

Convallaria Majalis

• Common Name:Lily of the valleyBotanical Name: Convallaria majalisPart Used:Flowers, leaves and root. The fresh leaves have the most potency.Family:Asparagaceae.

• Geographical distribution: Lily of the valley is native to Europe, but is found abundantly throughout the Eastern United States, Northern Asia and in England

• Chemical Constituents:Roughly 38 different cardiac glycosides have been found in lily of the valley, some among others: convallatoxin, convallotoxole, convallarin, convallamarin, convalloside, convallotoxoloside saponins, flavonoids, asparagin etc. Only two of these substances act directly on the heart.

• Convallamarin, the active principle, a white crystalline powder, readily soluble in water and in alcohol, but only slightly in ether, which acts upon the heart like Digitalin, and has also diuretic action, and Convallarin, which is crystalline in prisms, soluble in alcohol, slightly soluble in water and has a purgative action. There are also present a trace of volatile oil, tannin, salts, etc.

Mechanism of Action:• Herbalists have considered the roots of the Convallaria plant to be a

treatment for a weak heart, shortness of breath tachycardia and arrythmia.

• The Convallaria plant transforms convalloside (the basic metabolic glycoside) into convallatoxin and other cardiac glycosides.

• Convallatoxin affects vasoconstriction and vasodilation, and cardiac stroke volume, pulse pressure and cAMP activity are all enhanced by Convallaria.

• It is also a lipoxygenase inhibitor

Dosage:• Tincture (1:5, 40%), 0.5-1.0 ml. • Infusion: 1 tsp/cup. • Dried leaves: 60-200mg TID. • Short term use best (4-6 weeks).

Medicinal Uses:• It has similar but milder cardiac effects to Digitalis but without the toxic

buildup. • Exerts a positive inotropic and negative chronotropic action on the heart and is

specific for congestive heart failure with edema. • It is most indicated in bradycardic and/or arrhythmic forms of heart failure.• Mitral stenosis, mitral regurgitation and corpumonale are especially good

indications for its use.• In aromatherapy, the essential oil of lily of the valley is used to relieve

depression, imbue gentleness, happiness, modesty, a sweet disposition and sense of security.

• The herb has been used for weak contractions during childbirth as well as for epileptic seizures, strokes, angina and ensuing paralysis, conjunctivitis and leprosy.

Toxicity: Signs of toxicity: nausea, vomiting, violent purging, cardiac arrhythmias,

increased blood pressure, restlessness, trembling, mental confusion, extreme weakness, depression, collapse of circulation, and death. Monitor BP and edema. Berries are poisonous.

CONGESTIVE HEART FAILURE By Abdulllah Tariq

14659

CONGESTIVE CARDIAC FAILURE• Definition: Heart failure in which the heart is unable to maintain

adequate circulation of blood in the tissues of the body or increase in myocardial oxygen demand and decreased myocardial oxygen supply.

OR It is a common clinical disorder that results in pulmonary

vascular. congestion and reduced cardiac output. CHF patient usually presents with dyspnea and respiratory failure.

PATHOPHYSIOLOGY Pathology:• CHF arises as a consequence of an abnormality in cardiac

structure, function, rhythm, or conduction. • Ventricular dysfunction accounts for the majority of cases

and results mainly from myocardial infarction (systolic dysfunction), hypertension (diastolic and systolic dysfunction), or in many cases both.

• Degenerative valve disease, idiopathic cardiomyopathy, and alcoholic cardiomyopathy are also major causes of CHF.

CHF indicates inability of the heart to maintainadequate oxygen delivery; it is also a systemic responseattempting to compensate for the inadequacy. Thedeterminants of cardiac output include heart rate andstroke volume(the volume of blood pumped from the leftventricle per beat.). The stroke volume is furtherdetermined by the preload (the volume that enters theleft ventricle),contractility and afterload (the impedanceof the flow from the left ventricle).

PATHOPHYSIOLOGY Cont..

There are 2 mechanisms of reduced cardiacoutput and heart failure:• Systolic dysfunction • Diastolic dysfunction

Systolic Dysfunction

• The most common causes of systolic dysfunction (defined by a left-ventricular ejection fraction of 50%) are ischemic heart disease, idiopathic dilated cardiomyopathy, hypertension, and valvular heart disease.

Diastolic Dysfunction

• Diastolic dysfunction (defined as dysfunction of left-ventricular filling with preserved systolic function) may occur in up to 40–50% of patients with heart failure and it increases in frequency with each decade of life.

• Causes: Hypertension, ischemic heart disease, hypertrophic cardiomyopathy, and restrictive cardiomyopathy.

PATHOPHYSIOLOGYPhysiology:• Cardiac structural abnormality; ardiovascular response to poor

perfusion with the activation of the neurohumoral system.• Activation of the renin-angiotensin system attempts to increase

preload by stimulating retention of salt and water, increasing vasoconstriction, and augmenting cardiac contractility. Initially, this response will suffice, but prolonged activation results in loss of myocytes and maladaptive changes in the surviving myocytes.

• The stressed myocardium undergoes remodeling and dilation in response to the insult.

Cont…

• This process also has detrimental effects on the functioning of the lungs, kidneys, muscles, blood vessels, and probably other organs.

• Remodeling also results in additional cardiac decompensation from complications, including mitral regurgitation and cardiac arrhythmias from atrial remodeling.

Diagnosis and Treatment

Diagnosis:• The measurement of serum natriureticpeptide and echocardiography havesubstantially improved the accuracy ofdiagnosis.• Physical examination,chest radiography• Pulmonary congestion (with crackles and wheezing) is

predominant.

Treatment

Plants used in Congestive Heart Failure:

DIGITALIS LEAVES

• Common Name: Fox glove and purple foxglove.Botanical Name:Digitalis purpurea LinnPart Used: Dried Leaves.

• Family:Scrophulariaceae.• Geographical distribution: It is mainly found in

England, Germany, France, North• America, India, Iraq, Japan, Kurdistan, Mexico, Nepal.

Chemical Constituents:Digitalis essentially contains three important primary glycosides namely:

• Purpurea glycoside A, Purpurea glycoside B, and Purpurea glycoside C, which upon hydrolysis give rise to digitoxin, gitoxin and gitalin/gitaloxin respectively.

• These secondary glcosides on further hydrolysis yields noncarbohydrate moieties (called aglycones or genins) digitoxigenin, gitoxigenin and gitaligenin or gitaloxigenin respectively.

• The crude drug also contains a good number of other glycosides (e.g.; digitalin, diginin)

• Saponins (e.g.; digitonin, gitin and digitosaponin) • Tannins, gallic, formic, acetic, succinic and benzoic acids, fatty acids and • Enzyme digipuridase solely responsible for hydrolysis of purpurea glycosides.

Mechanism of action

• Digitalis works by inhibiting sodium-potassium ATPase. This results in an increased intracellular concentration of sodium ions and thus a decreased concentration gradient across the cell membrane. This increase in intracellular sodium causes the Na/Ca exchanger to reverse potential, i.e., transition from pumping sodium into the cell in exchange for pumping calcium out of the cell, to pumping sodium out of the cell in exchange for pumping calcium into the cell. This leads to an increase in cytoplasmic calcium concentration, which improves cardiac contractility.

• As a result of increased contractility, stroke volume is increased. Ultimately, digitalis increases cardiac output (Cardiac Output=Stroke Volume x Heart Rate). This is the mechanism that makes this drug a popular treatment for congestive heart failure, which is characterized by low cardiac output. Digitalis also has a vagal effect on the parasympathetic nervous system, and as such is used in re-entrant cardiac arrhythmias and to slow the ventricular rate during atrial fibrillation.

Medicinal Uses:• Digitalis enhances the force of contraction of heart muscle which ultimately affords

an increased cardiac output, decreased size of heart, decreased venous pressure and above all the decreased blood volume.

• Thus digitalis together with its various marketed preparations are employed profusely as vital cardiotonics in the management and control of different kinds of congestive heart failure, atrial flutter, atrial fibrillation, supraventricular tachycardia and premature extra systoles.

Dosage:Administer one-half the total loading dose initially (all formulations), then give one-fourth the total loading dose every 6 to 8 hours for two doses (IV and tablets), or give additional fractions every 4 to 8 hours (oral solution).-IV: 8 to 12 mcg/kg-Tablets: 10 to 15 mcg/kg-Oral solution: 10 to 15 mcg/kg.

ATHEROSCLEROSIS By: Daniyal Khan

14681

Intro to Atherosclerosis

• Atherosclerosis (also known as Arteriosclerotic Vascular Disease or ASVD) the condition in which an artery wall thickens as the result of a build-up of fatty materials such as cholesterol affecting arterial blood vessels, a chronic inflammatory response in the walls of arteries due to the accumulation of macrophage white blood cells and promoted by Low-density lipoproteins without adequate removal of fats and cholesterol from the macrophages by functional high density lipoproteins

• It is commonly referred to as a hardening or furring of the arteries.

• It is caused by the formation of multiple plaqueswithin the arteries.

• It can restrict blood flow. These plaques can also burst, causing a blood clot.

• Although atherosclerosis is often considered a heart problem, it can affect arteries anywhere in your body.

• Atherosclerosis is a preventable and treatable condition.

CausesAtherosclerosis starts with damage or injury to

the inner layer of an artery. The damage may be caused by:

• High blood pressure• High cholesterol• An irritant, such as nicotine• Certain diseases, such as diabetes

Pathophysiology

• Atherosclerosis develops as a chronic inflammatory response of the arterial wall to endothelial injury.

• Lesion progression occurs through interactions of modified lipoproteins, monocyte-derived macrophages, T-lymphocytes, and the normal cellular constituent of the arterial wall.

• The contemporary view of atherosclerosis is expressed by the response-to-injury hypothesis.

Response-to-injury hypothesis• The following are the

steps involved in the hypothesis:

1. Chronic endothelial injury

2. Accumulation of lipoproteins

3. Monocyte adhesion to the endothelium

4. SMC proliferations and ECM production

5. factor release6. platelet adhesion

1. Chronic endothelial injury

• with resultant endothelial dysfunction, causing increased permeability, leukocyte adhesion, and thrombosis

Response-to-injury hypothesis

2. Accumulation of lipoproteins • (mainly LDL and its oxidized forms) in the vessel

wall. Low-density lipoprotein molecules (LDL) becoming oxidized (ldl-ox) by free radicals, particularly oxygen free (ROS). When oxidized LDL comes in contact with an artery wall, a series of reactions occur to repair the damage to the artery wall caused by oxidized LDL. Cholesterol can move in the bloodstream only by being transported by lipoproteins


3. Monocyte adhesion to the endothelium• followed by migration into the intima and

transformation into macrophages and foam cells. The body's immune system responds to the damage to the artery wall caused by oxidized LDL by sending specialized white blood cells (macrophages and T-lymphocytes) to absorb the oxidized-LDL forming specialized foam cells. Unfortunately, these white blood cells are not able to process the oxidized-LDL, and ultimately grow then rupture, depositing a greater amount of oxidized cholesterol into the artery wall. This triggers more white blood cells, continuing the cycle.


4. platelet adhesion

5. factor release • from activated platelet,

macrophages and vascular wall cells, inducing SMC recruitment, either from the media or from the circulating precursors


6. SMC proliferations and ECM production. • Eventually, the artery becomes inflamed.

The cholesterol plaque causes the smooth muscle cells to enlarge and form a hard cover over the affected area. This hard cover is what causes a narrowing of the artery, reduces the blood flow and increases blood pressure.


7. Lipid accumulation • both extracellularly and within cells

(macrophages and SMC’s). accumulation if lipid-containing macrophages in the intima gives rise to “fatty streaks”, with further evolution, a fibrofatty atheroma consisting of proliferated SMC, foam cells, extracellular lipid, and ECM is formed.


Atherosclerosis symptoms depend on which arteries are affected. For example:

• Atherosclerosis in heart arteries, have symptoms similar to those of a heart attack, such as chest pain (angina).

• Atherosclerosis in the arteries leading to brain, have symptoms such as sudden numbness or weakness in your arms or legs, difficulty speaking or slurred speech, or drooping muscles in your face.

• Atherosclerosis in the arteries in arms and legs, produces decreased blood flow is called peripheral artery occlusive disease (PAOD).have symptoms such as leg pain when walking

• Sometimes atherosclerosis causes erectile dysfunction in men.

Symptoms

Depending on the results of the physical exam, doctors may suggest one or more diagnostic tests, including:

• Blood tests. • Doppler ultrasound• Ankle-brachial index. • Other imaging tests. • Angiogram. • Electrocardiogram (ECG).

Tests and diagnosis

Plants used in Atherosclerosis

Allium sativum

• Common Name:Garlic.Botanical Name:Allium sativum.

• Part Used:Bulbs and Rhizome.Family: Amaryllidaceae.Geographical distribution:Garlic is native to Central Asia (Kazakhstan, Kyrgyzstan, Turkmenistan, Tadzhikistan and Uzbekistan) and northeastern Iran

• Chemical costituents:Garlic contains 0.1-0.36% of a volatile oil. These are generally considered to be responsible for most of the pharmacological properties of garlic. Garlic contains at least 33 sulfur compounds like aliin, allicin, ajoene, allylpropl, diallyl, trisulfide, sallylcysteine, vinyldithiines, S-allylmercaptocystein, and others. Besides sulfure compounds garlic contains 17 amino acids and their glycosides, arginine and others. Minerals such as selenium and enzymes like allinase, peroxidases, myrosinase etc.the most biologically active compounds, allicin (diallylthiousulfinate or diallyl disulfide) does not exist in garlic until it is crushed or cut; injury to the garlic bulb activates the enzyme allinase, which metabolizes alliin to allicin

• Mechanism of Action:• Intact cells of garlic bulbs include an odorless, sulfur-containing amino acid known

as allinin.• When garlic is crushed, allinin comes into contact with allinase, which converts

allinin to allicin. Allicin has potent antibacterial properties, but it is also highly odoriferous and unstable.

• Ajoenes, self-condensation products of allicin, appear to be responsible for garlic's antithrombotic activity.

• Fresh garlic releases allicin in the mouth during the chewing process. Dried garlic preparations lack allicin but contain allinin and allinase. Since allinase is inactivated in the stomach, dried garlic preparations should be coated with enteric so that they pass through the stomach into the small intestine where allinin can be enzymatically converted to allicin.

• Medicinal Uses:• Lipid-lowering Effects: Garlic's lipid lowering effects may occur via inhibition of HMG-

CoA reductase or other enzymes, possibly by diallyl di- and trisulphide components of garlic.

• Platelet Effects: Garlic and its derived compound ajoene have demonstrated inhibition of platelet aggregation In vitro and in animals, and reduction of platelet-dependent thrombus formation.

• Fibrinolytic Effects: Increased fibrinolytic activity may account for some degree of garlic's anti-clotting effects, involving fibrinogen and plasminogen.

• Antimicrobial Effects (Bacteria, Fungi, Yeast): Garlic has been demonstrated In vitro to exert activity against multiple pathogens, including bacteria, including resistant strains, mycobacteria, Helicobacter pylori and fungi. Garlic extract has been found to be bactericidal to Histoplasmacapsulatum.Ajoene alone possesses antibacterial activity against both gram positive and negative bacterial species and inhibits yeast growth In vitro, and the disulfide bond in ajoene may be responsible for these effects.

• Lowering of blood glucose and blood pressure; and liver protection.• Unani physicians also use garlic to treat paralysis, forgetfulness, tremor, colic pains,

internal ulcers and fevers.

• DOSAGE:1. Atherosclerosis:A 300 mg garlic powder tablet taken as a single dose or three times daily.

• 2. For colon cancer and rectal cancer: Capsules containing 2.4 mL of aged garlic extract taken daily for 12 months have been used.

• 3. For high blood pressure: 300 mg to 1500 mg of garlic tablets taken in divided doses daily for 24 weeks.

• 4. For fungal skin infections (ringworm, jock itch, athlete's foot): garlic ingredient ajoene as a 0.4% cream, 0.6% gel, and 1% gel applied twice daily for one week has been used.

Punica granatum

• Common Name:Pomegranate.Botanical Name: Punicagranatum Linn

• Part Used: Fruit• Family: Lythraceae• Geographical region:

Pomegranate is native to a region from Iran to northern India. Pomegranates have been cultivated throughout the Middle East, South Asia, and Mediterranean region for several millennia, and also thrive in the drier climates of California and Arizona

• Chemical constituents:• Punicalagin• Punicallin• Punic acid• Gallagicacid• Granatin A • Casuarinin, • Pseudopelletierene

• Mechanism of action and medicinal uses:• The potential therapeutic properties of pomegranate are wide-ranging and include treatment and

prevention of cancer, cardiovascular disease, diabetes, dental conditions, erectile dysfunction, and protection from ultraviolet (UV) radiation.

• Other potential applications include infant brain ischemia, Alzheimer’s disease, male infertility, arthritis, and obesity.Plant pacifies tridosha, tapeworm infestation,

• Increase digestive power; alleviate fatigue and thirst and aphrodisiac. • The juice of fresh leaves and young Pomegranate is given in dysentery. • The powdered bark is given for expelling roundworms. • According to Kirtikar and Basu (1935) the unripe fruits and flowers are useful in inducing vomiting, the rind

of the fruit is given in diarrhoea and dysentery. • They also strengthen the gums. • Ripe fruit is tonic, laxative and enriches the blood. • The flower-buds are astringent, and are given in chronic diarrhoea and dysentery.

• Dose: • As an antioxidant 1000 milligrams of pomegranate

extract in the form of POMx™ capsules has been taken by mouth daily for four weeks. A dose of 50 milliliters of pomegranate juice has been taken by mouth daily for three months.

• A dose of 100 grams of fresh pomegranate fruit has been taken by mouth for 10 days.

REFERENCES

• http://jamanetwork.com/journals/jamainternalmedicine/fullarticle/210378

• http://www.sigmaaldrich.com/life-science/nutrition-research/learning-center/plant-profiler/allium-sativum.html

• Bentley and Trimen, Med. Plants 281. 3. Benkeblia, N. 2004. Antimicrobial activity of essential oil extracts of various onions Allium cepa& Garlic (Alliceasatium) lebeusmwiss-uTechnol. 373.

• Chemical constituents of cultivated onion Allium cepaLiliaceae.• https://restorativemedicine.org/journal/the-use-of-convallaria-

and-crataegus-in-the-treatment-of-cardiac-dysfunction/.

cardiac deseases and herbs use against them

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