Alternating Ventricular Complexes After Overdose From an Herbal Medication

Vo, Kathy T.; Tabas, Jeffrey A.; Smollin, Craig G.

doi:10.1001/jamainternmed.2017.1839

Cited by 10 publications

(10 citation statements)

References 11 publications

(17 reference statements)

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“…Even so, acute or chronic cardiac toxic effects often have still followed later, when AC‐containing herb medicines were improperly used nowadays. As reported in previous articles, up to 88.2% of patients with AC poisoning suffered polymorphous ventricular arrhythmias, including ventricular ectopics, ventricular tachycardia, torsade de points , and ventricular fibrillation, all of which are the commonest fatal cardiac side‐effects induced by AC 30‐33 . Besides, myocarditis or severe myocardial injuries were observed in some autopsy cases of AC poisoning.…”

Section: Introductionmentioning

confidence: 61%

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Cardiac efficacy and toxicity of aconitine: A new frontier for the ancient poison

Zhou¹,

Liu

Qiu

et al. 2021

Medicinal Research Reviews

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Aconitine (AC) is well‐known as the main toxic ingredient and active compound of Aconitum species, of which several aconites are essential herbal medicines of Traditional Chinese Medicine (TCM) and widely applied to treat diverse diseases for their excellent anti‐inflammatory, analgesic, and cardiotonic effects. However, the cardiotoxicity and neurotoxicity of AC attracted a lot of attention and made it a favorite botanic poison in history. Nowadays, the narrow therapeutic window of AC limits the clinical application of AC‐containing herbal medicines; overdosing on AC always induces ventricular tachyarrhythmia and heart arrest, both of which are potentially lethal. But the underlying cardiotoxic mechanisms remained chaos. Recently, beyond its cardiotoxic effects, emerging evidence shows that low doses of AC or its metabolites could generate cardioprotective effects and are necessary to aconite's clinical efficacy. Consistent with TCM's theory that even toxic substances are powerful medicines, AC thus could not be simply identified as a toxicant or a drug. To prevent cardiotoxicity while digging the unique value of AC in cardiac pharmacology, there exists a huge urge to better know the characteristic of AC being a cardiotoxic agent or a potential heart drug. Here, this article reviews the advances of AC metabolism and focuses on the latest mechanistic findings of cardiac efficacy and toxicity of this aconite alkaloid or its metabolites. We also discuss how to prevent AC‐related cardiotoxicity, as well as the issues before the development of AC‐based medicines that should be solved, to provide new insight into the paradoxical nature of this ancient poison.

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Section: Introductionmentioning

confidence: 61%

“…Aconitine (AC) is a C 19 ‐diester diterpenoid alkaloid (DDA) derived from Aconitum ( Ranunculaceae ), which is also named aconite or Wutou 1,2 . This aconite alkaloid has an extremely low lethal dose (0.2 mg) for humans and is generally violently poisonous 3,4 .…”

Section: Introductionmentioning

confidence: 99%

Cardiac efficacy and toxicity of aconitine: A new frontier for the ancient poison

Zhou¹,

Liu

Qiu

et al. 2021

Medicinal Research Reviews

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“…Most of the studies (49/73, 67.1 %) were published in the last ten years, with the oldest published case dating back to 1984. 12 other publications were analysed separately due to ambiguity over the temporal sequence of events (whether ECPR was necessary to achieve ROSC or whether ROSC had been achieved with conventional CPR instead) [Supplement 2] [82] , [83] , [84] , [85] , [86] , [87] , [88] , [89] , [90] , [91] , [92] , [93] .…”

Section: Resultsmentioning

confidence: 99%

Extracorporeal cardio-pulmonary resuscitation in poisoning: A scoping review article

Wong

Ponampalam

2023

Resuscitation Plus

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“…Bidirectional VT is a rare arrhythmia usually associated with digoxin toxicity or familial catecholaminergic polymorphic VT [6]. In a review of 72 cases of bidirectional VT, digoxin was implicated in 82% of patients [7].…”

Section: Discussionmentioning

confidence: 99%

“…One group reported the presence of this arrhythmia in myocardial infarction [8]. However, aconite poisoning can also cause bidirectional VT and should be included in the differential diagnosis when an unstable patient presents with this arrhythmia [1,6,9]. The diagnosis of aconite toxicity requires a high level of clinical suspicion, as there are no readily available assays in North America for its detection.…”

Section: Discussionmentioning

confidence: 99%

Bidirectional ventricular tachycardia secondary to aconite toxicity after ingestion of a Chinese herbal supplement in Canada

Czarnecki¹,

Hansen²,

Bucci³

2018

Int J Case Rep Images

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Introduction: Aconite is commonly used in traditional Chinese medicine but if incorrectly prepared or consumed in excessive doses, can cause significant cardiac toxicity and death. The cardiac sequelae include hypotension, bradycardia, and ventricular arrhythmias, including bidirectional ventricular tachycardia. The diagnosis is made clinically and management is supportive. Case Report: A 44-year-old male was admitted to the hospital post cardiac arrest. It was discovered that he had ingested significant quantities of the Chinese herbal medication "Fu Zi" or "Aconite" prior to admission. His rhythm on telemetry consisted of monomorphic ventricular tachycardia, bidirectional ventricular tachycardia, and ventricular fibrillation. Repeated cardioversions as well therapy with amiodarone was required. The patient's arrhythmias subsided after 24 hours, but the patient had developed global hypoxic

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Alternating Ventricular Complexes After Overdose From an Herbal Medication

Cited by 10 publications

References 11 publications

Cardiac efficacy and toxicity of aconitine: A new frontier for the ancient poison

Cardiac efficacy and toxicity of aconitine: A new frontier for the ancient poison

Extracorporeal cardio-pulmonary resuscitation in poisoning: A scoping review article

Bidirectional ventricular tachycardia secondary to aconite toxicity after ingestion of a Chinese herbal supplement in Canada

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