{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,16]],"date-time":"2026-10-16T23:00:59Z","timestamp":1792191659970,"version":"4.4.0"},"reference-count":15,"publisher":"Oxford University Press (OUP)","issue":"1","license":[{"start":{"date-parts":[[2022,1,19]],"date-time":"2022-01-19T00:00:00Z","timestamp":1642550400000},"content-version":"vor","delay-in-days":18,"URL":"https:\/\/creativecommons.org\/licenses\/by-nc\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2022,1,4]]},"abstract":"<jats:title>Abstract<\/jats:title>\n               <jats:sec>\n                  <jats:title>Background<\/jats:title>\n                  <jats:p>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.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Case summary<\/jats:title>\n                  <jats:p>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 V1. 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\u2019s heart rate abruptly decreased without other intervention. Electrocardiogram showed a change in P-wave morphology in lead V1 from upright to biphasic (+\/\u2212) after conversion to normal sinus rhythm. Thus, a diagnosis of atrial tachycardia originating at or near the donor right superior pulmonary vein was favoured.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Discussion<\/jats:title>\n                  <jats:p>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.<\/jats:p>\n               <\/jats:sec>","DOI":"10.1093\/ehjcr\/ytac023","type":"journal-article","created":{"date-parts":[[2022,1,19]],"date-time":"2022-01-19T12:06:12Z","timestamp":1642593972000},"source":"Crossref","is-referenced-by-count":2,"title":["Taken to heart\u2014arrhythmic potential of heart-leaf sida, a banned ephedrine alkaloid: a case report"],"prefix":"10.1093","volume":"6","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-4137-8926","authenticated-orcid":false,"given":"Evaline","family":"Cheng","sequence":"first","affiliation":[{"name":"Department of Medicine, David Geffen School of Medicine, University of California, Los Angeles, Los Angeles, CA, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ruth","family":"Hsiao","sequence":"additional","affiliation":[{"name":"Department of Medicine, Division of Cardiology, David Geffen School of Medicine, University of California, Los Angeles, Los Angeles, CA, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Zenaida","family":"Feliciano","sequence":"additional","affiliation":[{"name":"Department of Medicine, Cardiac Arrhythmia Center, David Geffen School of Medicine, University of California, Los Angeles, Los Angeles, CA, USA"},{"name":"Department of Medicine, Cardiac Arrhythmia Center, VA Greater Los Angeles Healthcare System, 11301 Wilshire Blvd 111E, Los Angeles, CA 90073, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jaime","family":"Betancourt","sequence":"additional","affiliation":[{"name":"Department of Medicine, Division of Pulmonary and Critical Care Medicine, VA Greater Los Angeles Healthcare System, Los Angeles, CA, USA"},{"name":"Department of Medicine, Division of Pulmonary and Critical Care Medicine, David Geffen School of Medicine, University of California, Los Angeles, Los Angeles, CA, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-2393-7018","authenticated-orcid":false,"given":"Janet K","family":"Han","sequence":"additional","affiliation":[{"name":"Department of Medicine, Cardiac Arrhythmia Center, David Geffen School of Medicine, University of California, Los Angeles, Los Angeles, CA, USA"},{"name":"Department of Medicine, Cardiac Arrhythmia Center, VA Greater Los Angeles Healthcare System, 11301 Wilshire Blvd 111E, Los Angeles, CA 90073, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"286","published-online":{"date-parts":[[2022,1,19]]},"reference":[{"key":"2022013009112347500_ytac023-B1","doi-asserted-by":"crossref","first-page":"1188","DOI":"10.1016\/j.jacc.2016.11.078","article-title":"Herbal medications in cardiovascular medicine","volume":"69","author":"Liperoti","year":"2017","journal-title":"J Am Coll Cardiol"},{"key":"2022013009112347500_ytac023-B2","doi-asserted-by":"crossref","first-page":"e92265","DOI":"10.1371\/journal.pone.0092265","article-title":"Usage of plant food supplements across six European countries: findings from the PlantLIBRA consumer survey","volume":"9","author":"Garcia-Alvarez","year":"2014","journal-title":"PLoS One"},{"key":"2022013009112347500_ytac023-B3","author":"Food and Drug Administration. 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