Can Natural Remedies Jeopardize Cardiovascular Health?

Chinese physicians report on a case of potentially lethal cardiovascular symptoms induced by a traditional Chinese medicine component (aconitine), in the Canadian Journal of Cardiology

Philadelphia, PA, November 19, 2015

Chinese physicians report on the case of a woman who presented with aconitine-induced cardiovascular symptoms. Their report, published in the Canadian Journal of Cardiology, warns that the use of this natural ingredient may lead to severe poisoning.

A 45-year-old Chinese woman was diagnosed with a severe heart-rhythm disorder, bidirectional ventricular tachycardia (BVT), associated with aconitine poisoning. BVT is a rare form of tachycardia (characterized by a resting heart rate over 100 beats per minute) and a distinct pattern of ECG waves on presentation.

The patient’s husband reported that she had drunk about 50 milliliters of a medicinal liquid about 30 minutes before she developed a sudden drop in blood pressure and then lost consciousness. The woman had no history of previous heart-rhythm problems and there was no family history of unexpected sudden death or fatal accidents. On examination she had a heart rate of 150 beats per minute and her blood pressure was 50/30. Her skin was cool, moist, and cyanotic. Treatment with the antiarrhythmic agents amiodarone, metoprolol, lidocaine, and potassium chloride was ineffective. An abdominal ultrasound showed marked gastric retention. A gastric tube was used to suction out the contents of her stomach. After two hours, the patient’s BVT ceased and her circulation improved.

Investigation revealed that the patient’s blood was positive for aconitine, a substance produced by the Aconitum plant, also known as devil’s helmet or monkshood. Although well-known for its highly toxic properties, aconitine is the primary ingredient of the traditional Chinese medicine known as Fuzi, a remedy made from the processed lateral roots of Aconitum carmichaeli Debx. It is widely distributed in the southwest provinces of China and is used in small doses for its anti-inflammatory and pain-relieving effects.

“Management of potentially lethal ventricular tachyarrhythmia associated with aconitine poisoning presents a therapeutic challenge. In a previously published case, amiodarone was effective in suppressing the BVT. However, in our patient, both lidocaine and amiodarone were ineffective,” explained lead author Zhong Yi, MD, PhD, of the Aerospace Center Hospital, Beijing, People’s Republic of China.

“The public should be warned of the risk of severe poisoning that can accompany traditional Chinese medicinal usage of Fuzi,” Dr. Yi concluded.

Commenting on the report, P. Timothy Pollak, MD, PhD, FRCPC, of the Department of Medicine at the University of Calgary, Alberta, cautioned that “not all products of Mother Nature are free of harm. This case report reminds us that aconitine is not the only naturally derived substance that can cause potentially lethal ventricular tachyarrhythmias, including BVT. The report also demonstrates the human tendency to think that if a little is good, more must be better.”

Dr. Pollak advises clinicians to be aware of what their patients are taking and be prepared to discuss alternative remedies, at least at a basic level. “Dodging the discussion can only lend credibility to any patient suspicions that as a practitioner of Western medicine, you have been denied the secrets of alternative remedies or are hiding them for ulterior motives. This report serves as a timely illustration that alternative remedies do have implications for the practice of cardiology that cannot be ignored.”

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Notes for Editors
“An Unusual Etiology for Bidirectional Ventricular Tachycardia,” by Yun-Tao Zhao, MD, PhD, Lei Wang, MD, and Zhong Yi, MD, PhD (DOI: http://dx.doi.org/10.1016/j.cjca.2015.06.024).Author contact via the Media Department at +8613701270505, +86 10 59971884, or yzmed@163.com.

“Herbal Cardiotoxicity: Can Mother Nature Hurt the Heart?” by P. Timothy Pollak, MD, PhD, FRCPC (DOI: http://dx.doi.org/10.1016/j.cjca.2015.08.024).Author contact: +1 403 210 8694 or pollak@ucalgary.ca or via Doug Ferguson, Communications Advisor, Cumming School of Medicine, University of Calgary, at +1 403 220 2232, +1 403 604 3584 (mobile), or doug.ferguson@ucalgary.ca.

These articles appear online in advance of publication of an issue of the Canadian Journal of Cardiology, published by Elsevier.

Full text of this article and editorial is available to credentialed journalists upon request. Contact Eileen Leahy at +1 732 238 3628 or cjcmedia@elsevier.com to obtain copies.

About the Canadian Journal of Cardiology 
The Canadian Journal of Cardiology is the official journal of the Canadian Cardiovascular Society. It is a vehicle for the international dissemination of new knowledge in cardiology and cardiovascular science, particularly serving as a major venue for the results of Canadian cardiovascular research and Society guidelines. The journal publishes original reports of clinical and basic research relevant to cardiovascular medicine as well as editorials, review articles, case reports, and papers on health outcomes, policy research, ethics, medical history, and political issues affecting practice.

About The Editor-in-Chief
Editor-in-Chief Stanley Nattel, MD, is Paul-David Chair in Cardiovascular Electrophysiology and Professor of Medicine at the University of Montreal and Director of the Electrophysiology Research Program at the Montreal Heart Institute Research Center.

About The Canadian Cardiovascular Society
The Canadian Cardiovascular Society is the professional association for Canadian cardiovascular physicians and scientists working to promote cardiovascular health and care through knowledge translation, professional development, and leadership in health policy. The CCS provides programs and services to its 1900+ members and others in the cardiovascular community, including guidelines for cardiovascular care, the annual Canadian Cardiovascular Congress, and, with the Canadian Cardiovascular Academy, programs for trainees. More information about the CCS and its activities can be found at www.ccs.ca.

About Elsevier
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Elsevier
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cjcmedia@elsevier.com