Bradycardia and Hypotension from Improper Use of Aconite Root: A Case Report and Brief Review

Abstract

Background: Adverse reactions associated with Chinese herbal medicines (CHMs) are usually the result of unpredictable active/toxic ingredients, inaccurate or mistaken beliefs, or poor supervision. The herb that most commonly induces severe adverse effects in Hong Kong and China is aconite root. More than 200 species of Aconitum plants are used for medicinal purposes, with aconite roots producing analgesic, anti-inflammatory, cardiotonic, and anti-tumor effects. The active components are alkaloids; these can be toxic, but CHM processing methods lower their toxicity and increase the pharmacological efficacy. However, aconite poisoning can result from inadequate decoction time or exceeding the recommended dose. Case Report: Here we report the case of a 92-year-old woman who presented with life-threatening bradycardia and hypotension. This started 1 h after she inappropriately consumed a herbal decoction containing Fuzi for mood fluctuation and health maintenance; Fuzi, an aconite root, has known cardiotoxicity. Electrocardiography showed supraventricular abnormalities, including sinus bradycardia and low-amplitude P waves. After an infusion of normal saline and inotropic agents for 25 h, the clinical manifestations subsided, her sinus rhythm returned to normal, and she was discharged. At follow-up 2 weeks later, she was in good health and had ceased taking any CHM. Conclusions: Standardized processing methods, stringent regulations, and cooperation between health professions can ensure medication safety and establish a fully-fledged operating process for these valuable drugs. We hope this report will help establish correct attitudes toward CHM and will assist Traditional Chinese Medicine practitioners to become more familiar with Aconitum plants.

The toxicology and detoxification of Aconitum: traditional and modern views

“…A 92-year-old woman took a herbal decoction containing Fuzi to treat her mood swings and maintain health, and was soon appeared to be life-threatening with bradycardia and hypotension after 1 h [ 113 ]. ECG showed ventricular abnormalities, including sinus bradycardia and low-P wave.…”

Risk Compounds, Preclinical Toxicity Evaluation, and Potential Mechanisms of Chinese Materia Medica–Induced Cardiotoxicity

“…Therefore, disturbance of I Ca-L channel can lead to fatal cardiac arrhythmias (Eden et al, 2016). Bradycardia and hypotension caused by improper use of aconite may be attributed to the inhibition of I Ca-L channels (Chou et al, 2018). Aconitine could block I Ca-L channels and calciuminduced calcium release (CICR) in human-induced pluripotent stem cell-derived cardiomyocytes (hiPSC-CMs) (Wu et al, 2017).…”