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Related Concept Videos

Mechanism of Cardiac Arrhythmias01:28

Mechanism of Cardiac Arrhythmias

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Arrhythmias are irregular heart rhythms occurring when the heart's electrical impulses become abnormal. These disturbances can lead to various symptoms, depending on their severity and the underlying cause. Some common factors contributing to arrhythmias include hypoxia, ischemia, electrolyte imbalances, excessive catecholamine exposure, drug toxicity, and muscle overstretching. Arrhythmias can be classified into two main types based on the rate and site of origin of abnormal heart rhythms.
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Antiarrhythmic Drugs: Class II Agents as β-Adrenergic Blockers01:24

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Adrenergic stimulation generally impacts cardiac rate and rhythm. Specifically, stimulation of the β-adrenoceptors triggers an increase in intracellular calcium ion influx and pacemaker currents, which may cause arrhythmias. Catecholamines like adrenaline also demonstrate β2-adrenoceptor-mediated hypokalemia, impacting cardiac action potential and disrupting the normal cardiac rhythm. Class II antiarrhythmic drugs are β-adrenoceptor antagonists or β-blockers, which...
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Antiarrhythmic Drugs: Class III Agents as Potassium Channel Blockers01:12

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Class III antiarrhythmic drugs are a group of medications that can prolong action potentials in the heart. They achieve this by blocking potassium channels or enhancing inward currents from sodium channels. However, these drugs have a unique property of "reverse use-dependence," which is most pronounced at slower heart rates and can lead to torsades de pointes—a specific type of arrhythmia. However, it is essential to note that excessive QT interval prolongation—a measure of...
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Heart Failure Drugs: Inotropic Agents01:26

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Positive inotropic agents are commonly used as the first line of treatment for heart failure. One such agent is digoxin, derived from the genus Digitalis, which has been known for centuries but effectively utilized since 1785. However, these cardiac glycosides can have potentially toxic effects due to their mechanism of action, which involves inhibiting Na+/K+-ATPase and increasing contractility. Digoxin is absorbed orally and distributed in various tissues, including the CNS. It has a long...
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Electrophysiology of Normal Cardiac Rhythm01:19

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The normal cardiac rhythm is a synchronized electrical activity that facilitates the regular and coordinated contraction of the heart muscle. This process is essential for efficient blood circulation throughout the body. The fundamental elements involved in establishing and maintaining this rhythm include the unique electrical properties of cardiac muscle cells, the sinoatrial (SA) node's pacemaker function, the specialized conducting system, and the ionic mechanisms underlying each phase...
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ECG Interpretation of Arrhythmias II: Atrial, Junctional and Ventricular Arrhythmias01:25

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Arrhythmia is a condition characterized by an irregular heart rhythm, with ECG changes that differ based on its origin and nature. The types of arrhythmias discussed below include atrial, junctional, and ventricular arrhythmias.Atrial ArrhythmiasPremature Atrial Complexes (PACs): PACs are early atrial beats caused by stress, caffeine, alcohol, electrolyte imbalances, hypoxia, hyperthyroidism, or certain medications (e.g., bronchodilators and decongestants). The ECG shows early P waves with an...
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Ginkgo Biloba: Plant-Based Proarrhythmic Potential?

Sami J Natour1, Sarah J Goldberg2, Evangelos A Diamantakos3

  • 1David Geffen School of Medicine, Department of Medicine, University of California-Los Angeles, Los Angeles, California.

JACC. Case Reports
|July 28, 2021
PubMed
Summary

Ginkgo biloba, a popular herbal supplement, may cause heart rhythm problems. Discontinuing Ginkgo extract resolved a patient's significant ventricular ectopic burden, suggesting a potential proarrhythmic effect.

Keywords:
ECG, electrocardiogramNSVT, nonsustained ventricular tachycardiaPVC, premature ventricular contractionbeta-blockerselectrocardiogramherbal supplementspremature ventricular contractionsventricular tachycardia

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Area of Science:

  • Cardiology
  • Pharmacology
  • Herbal Medicine Research

Background:

  • Ginkgo biloba is a widely consumed herbal supplement in the United States.
  • Ventricular ectopic burden can significantly impact cardiac health and function.

Observation:

  • A 63-year-old male patient presented with a high ventricular ectopic burden (32.7%).
  • This burden was resistant to standard treatment with metoprolol tartrate (41.7% efficacy).

Findings:

  • Discontinuation of Ginkgo leaf extract led to a dramatic resolution of the ventricular ectopic burden (<1%).
  • This observation suggests a direct link between Ginkgo consumption and cardiac arrhythmia.

Implications:

  • This case highlights a potential proarrhythmic side effect associated with over-the-counter Ginkgo leaf extract.
  • Further research is warranted to investigate the cardiovascular safety of Ginkgo biloba, especially in individuals with pre-existing cardiac conditions.