Medicinal herbs and some derivatives have been used in the treatment of heart disease which is rarely responsible for ventricular arrhythmias and cardiac arrest. Ventricular tachycardia (VT) increases the risk of sudden cardiac death (SCD). However, only a few reports are available about the cardiac ventricular arrhythmia followed by taking herbal medicines. We present two patients (a couple) without a history of heart disease who referred to the hospital with ventricular arrhythmia.
VT is caused by the activity of abnormal ventricular foci. It is mostly developed due to either acute myocardial infarction or advanced cardiomyopathy [
Patients were a middle-aged couple with a history of hypertension who referred to a public hospital with acute abdominal pain and periodic palpitation. Acute abdominal pain in both patients was due to the consumption of herbal medicines for reducing emotional stress including (a) Echium amoenum (containing saponins, flavonoids, unsaturated terpenoids, and sterols [
Ventricular arrhythmia (an automatic focus, monomorphic, and nonsustained VT) without hemodynamic effects was seen in the male and female case for 24 hours and 1 hour, respectively, after receiving the first dose of amiodarone. Ultrasound, abdominal X-ray, exercise test, and echocardiography were performed in both patients, showing normal results. The patients’ electrocardiogram (ECG) was normal on the second day of hospitalization, at the time of discharge, and 3 months later. After the treatment and discharge, the patients were followed up for three months (monthly) with Holter monitoring for 24 hours. No sign of arrhythmia was observed. Follow-up was performed to test the herbal medicines used; however, we did not access them.
A 64-year-old male patient with no medical or coronary heart disease history referred to a public hospital for acute abdominal pain. A specialist in the emergency department clinically examined the patient’s abdominal pain, weakness, and numbness. The patient had abdominal pain, weakness, numbness, sweating, dryness, and burning mouth for 1 hour. The abdominal pain was localized to the epigastric region spread to the back and got worse with 7/10 intensity after lying down. The patient reported no change in his bowel habits, no nausea and vomiting, and no history of trauma to his chest or abdomen. He also had no history of substance or alcohol use.
Abdominal pain and its symptoms appeared after drinking medicinal herbs. The abdomen was soft without tenderness and rebound tenderness. Gastrointestinal consultation showed no abnormality. The patient had a blood pressure of 80/50 and a heart rate of 115 beats per minute (bpm). The lung and heart sounds were normal and the pulse of the distal organs was full and symmetrical. The patient was also evaluated for myocardial infarction (MI), and the troponin test was negative. An irregular heartbeat was observed in the patient’s ECG and cardiac monitoring (Figure
Male patient’s ECG, ventricular arrhythmia (run of VT).
A 50-year-old woman with no family history of coronary heart disease referred to a public hospital for acute abdominal pain for 1 hour. The specialist in the emergency department examined the patient. She complained of abdominal pain, fatigue, and generalized weakness without dizziness. The patient had tingling and numbness of the lower jaw and hands.
The abdominal pain was localized to the epigastric region with 6/10 intensity, which was constant in nature and did not radiate elsewhere. The patient had no recent travel and no sign of substance or alcohol use.
Abdominal pain and associated symptoms appeared after drinking medicinal herbs. The patient’s abdomen was soft with no tenderness. She had a history of hypothyroidism and hysterectomy. Her blood pressure was 95/50 mmHg with a heart rate of 92 bpm. Gastrointestinal counseling showed no abnormality. The patient’s ECG showed ventricular arrhythmia (monomorphic with fusion beats, an automatic focus, variable cycle length, and nonsustained VT) at a rate of 92 bpm (Figure
Female patient’s ECG, ventricular arrhythmia (run of VT).
Herbal medicines have been used for centuries over time. However, the side effects associated with them need to be evaluated and understood [
Citrus aurantium extract contains p-synephrine. It is generally assumed that p-synephrine will increase heart rate and blood pressure [
Jambi studied the cardiac effects of Matricaria chamomilla L. and showed the effectiveness of this extract in reducing doxorubicin-induced cardiac toxicity [
Since herbal medicines are widely used for treating various diseases, it is necessary to pay attention to their toxic effects on cardiac function. Health professionals should consider the use of herbal medicines and their effects on the diagnosis and treatment of patients. The evaluation of the patients showing herbal side effects can provide valuable insights to better understand clinical effects of these medicinal plants and identify adverse cardiovascular reactions.
Written informed consent was obtained from the patients for publication of this case series and accompanying images.
The authors report no conflicts of interest in this project.
The authors would like to thank the Clinical Research Development Unit for its support and collaboration (IR.RUMS.REC.1399.152) in Ali-Ibn Abi-Talib Hospital, Rafsanjan University of Medical Sciences, Rafsanjan, Iran.