Cardiac Toxicity of Plant-Derived Glycosides
Summary
Plant-derived glycosides, notably the cardenolide and bufadienolide families exemplified by digoxin, digitoxin and oleandrin, are potent modulators of cardiac function. These compounds exert effects by inhibiting the Na+/K+-ATPase pump on cardiomyocyte membranes, leading to increased intracellular sodium, altered calcium handling and enhanced contractility. While this mechanism underpins therapeutic applications in heart failure, the narrow therapeutic window of these agents renders them liable to induce conduction disturbances, bradyarrhythmias, ventricular tachycardia and multifocal myocardial necrosis when misused or overdosed. Sources span traditional medicinal plants such as Nerium oleander, Digitalis spp. and Thevetia peruviana, and exposure may occur through accidental ingestion, self-medication, contaminated foodstuffs or herbal remedies. Histopathological findings in affected hearts include cardiomyocyte vacuolation, coagulative necrosis, inflammatory infiltration and fibrotic replacement. Given their dual role as remedies and poisons, plant-derived cardiac glycosides remain of global concern for clinical toxicology, veterinary health and food safety monitoring.
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Cardiac Toxicity of Plant-Derived Glycosides publication trend
The graph below shows the total number of articles in cardiac toxicity of plant-derived glycosides across all publications each year (not limited to Nature Index journals).
Technical terms
Cardiac glycoside: A plant-derived steroidal molecule that binds and inhibits Na+/K+-ATPase, altering cardiac ion homeostasis and contractility.
Na+/K+-ATPase: A membrane enzyme essential for maintaining intracellular sodium and potassium gradients, crucial for electrical stability in heart muscle cells.
Therapeutic window: The dosage range of a drug that achieves desired effects without producing unacceptable toxicity.
Cardiomyocyte: A specialised muscle cell of the heart responsible for generating contractile force and conducting electrical impulses.
Arrhythmia: A deviation from normal heart rhythm due to disturbances in cardiac electrical conduction or ion-channel function.
References
- Deliberate Self-Poisoning with Plants in Southeastern France, a Poison Center 20-Year Report. Toxins (2023).
- Oleandrin: A Systematic Review of its Natural Sources, Structural Properties, Detection Methods, Pharmacokinetics and Toxicology. Frontiers in Pharmacology (2022).
- Outbreak of Oleander (Nerium oleander) Poisoning in Dairy Cattle: Clinical and Food Safety Implications. Toxins (2020).
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