Cheng Evaline, Hsiao Ruth, Feliciano Zenaida, Betancourt Jaime, Han Janet K
Department of Medicine, David Geffen School of Medicine, University of California, Los Angeles, Los Angeles, CA, USA.
Department of Medicine, Division of Cardiology, David Geffen School of Medicine, University of California, Los Angeles, Los Angeles, CA, USA.
Eur Heart J Case Rep. 2022 Jan 19;6(1):ytac023. doi: 10.1093/ehjcr/ytac023. eCollection 2022 Jan.
Ephedra and ephedrine alkaloids were commonly used in herbal supplements before being prohibited by the European Commission and US Food and Drug Administration. However, ongoing, unknowing use by consumers can lead to potential adverse cardiovascular effects, such as arrhythmias.
A 65-year-old-man with a history of idiopathic pulmonary fibrosis status post-right single lung transplant was admitted for dizziness and resting tachycardia. Electrocardiogram showed a narrow complex, long R-P tachycardia with upright P-waves in lead . An initial workup suggested an arrhythmia associated with the consumption of an herbal supplement containing heart-leaf sida, a banned botanical ephedrine alkaloid. After the supplement was discontinued, the patient's heart rate abruptly decreased without other intervention. Electrocardiogram showed a change in P-wave morphology in lead from upright to biphasic (+/-) after conversion to normal sinus rhythm. Thus, a diagnosis of atrial tachycardia originating at or near the donor right superior pulmonary vein was favoured.
Atrial tachycardia can be precipitated by the proarrhythmic effects of ephedrine alkaloids, especially in patients with underlying risk factors and susceptible atrial anatomical substrate post-lung transplantation. Despite being banned by the European Union and the USA, ephedrine alkaloids continue to be used in over-the-counter herbal supplements and may go undetected by consumers. Ongoing vigilance for ephedrine alkaloids, more rigorous regulation, and active patient education can help reduce potential cardiovascular adverse events.
麻黄和麻黄碱生物碱在被欧盟委员会和美国食品药品监督管理局禁止之前，常用于草药补充剂中。然而，消费者不知情的持续使用可能会导致潜在的心血管不良反应，如心律失常。
一名65岁男性，有特发性肺纤维化病史，右肺单肺移植术后，因头晕和静息性心动过速入院。心电图显示窄QRS波、长R-P心动过速，导联 中P波直立。初步检查提示心律失常与食用一种含有心叶黄花稔的草药补充剂有关，心叶黄花稔是一种被禁止的植物麻黄碱生物碱。停用该补充剂后，患者心率在未进行其他干预的情况下突然下降。转为正常窦性心律后，心电图显示导联 中P波形态从直立变为双相（±）。因此，倾向于诊断为起源于供体右上肺静脉或其附近的房性心动过速。
麻黄碱生物碱的促心律失常作用可诱发房性心动过速，尤其是在有潜在危险因素且肺移植后心房解剖结构易感性增加的患者中。尽管麻黄碱生物碱已被欧盟和美国禁止，但仍继续用于非处方草药补充剂中，消费者可能无法察觉。对麻黄碱生物碱保持持续警惕、加强监管以及积极开展患者教育有助于减少潜在的心血管不良事件。
