© 2005 The European Society of Cardiology. Published by Elsevier Ltd. All rights reserved.
CASE REPORT
Transient complete atrioventricular block associated with herb intake
University of Ioannina and Preveza General Hospital Greece
Manuscript submitted 12 September 2004. Accepted after revision 29 September 2004.
*Corresponding author. University of Ioannina, 1 University Avenue, 45110 Ioannina, Greece. Tel.: +30 265 1097533; fax: +30 265 1097017. E-mail address: thkolet{at}cc.uoi.gr (T.M. Kolettis).
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Abstract |
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We report a case of transient complete atrioventricular block in a 38-year-old man, after intake of a mixture of herbs, intended to aid cigarette smoking cessation. Since all other causes of conduction disturbances were excluded, a side-effect of the herbal remedy was identified as the most likely diagnosis. Given that most patients are unaware of the potential risks of the intake of various herbs, we would urge that their usage be regulated.
Key Words: herbs, side-effects, atrioventricular block
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Introduction |
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Herbs are widely used for various indications, not only in the Far East, but also in Europe and in the United States. Although the nature of these herbs is mostly benign, side-effects associated with their intake have been described [1]
. We report what we believe to be the first case of complete heart block, associated with the ingestion of herbs. |
Case report |
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A 38-year-old man, chronic smoker, visited an anti-smoking centre, claiming to aid cigarette smoking cessation with a mixture of herbs. These herbs were contained in tablets, as well as in a solution. He was instructed to take one tablet and 20 drops twice daily.
The patient commenced the remedy as instructed and on the next day he experienced repeated dizzy spells, near-syncope and syncope. He was taken to the Emergency Department, where he experienced another syncopal episode. An electrocardiogram at that time showed complete atrioventricular block and a temporary pacing wire was urgently inserted through the left subclavian vein.
The patient was transferred to the Coronary Care Unit, where he remained for a total of seven days. He was pacemaker-dependent for four days, with complete absence of atrial and ventricular electrical activity. On the fifth and sixth day, pacing rhythm was occasionally interrupted by intrinsic activity. During his hospital stay, he underwent a complete work-up for possible causes of atrioventricular conduction disturbances. To the best of our knowledge, all such causes were excluded. In particular, no diagnosis of myocardial ischaemia/infarction, myocarditis, infectious diseases (toxoplasmosis, or, especially, Lyme disease), electrolyte abnormalities, sarcoidosis, amyloidosis, collagen vascular or neuromuscular diseases could be made.
On the seventh day, normal sinus rhythm with 1:1 conduction was present and the temporary pacing wire was removed. He underwent an electrophysiological study for assessment of the sinus node and the atrioventricular conduction system. All measurements were within normal limits, and he was discharged on no medication.
Seven months after his hospitalization, the patient remains well. During the follow-up period, repeated 24-h Holter recordings, echocardiography and treadmill exercise tests have been normal.
A drug-effect as a cause of the complete heart block was suspected and, as the patient denied any other medication intake, samples of the "anti-smoking" tablets and solution were sent for analysis and the appropriate authorities were notified.
The ingredients of the herbal remedies were reported as follows:
- Tablets:
- Ribes nigrum (Black Currant), 50 mg
- Helicrysum italicum,
- Taraxacum officinale,
- Uncaria tomentosa,
- Vitamin C 100 mg,
- Vitamin E 100 mg.
- Ribes nigrum (Black Currant), 50 mg
- (b) Solution:
- Fumaria officinalis,
- Melissa officinalis,
- Equisetum arvense.
- Fumaria officinalis,
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Discussion |
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Although diverse pharmacological actions of the herbs contained in the "anti-smoking" remedy have been suggested [2–
5], no clinical studies on their isolated or combined usage have been conducted. Thus, side-effects associated with the use of these herbs might be more common than those described to date [1]. We believe that the complete atrioventricular block observed in our patient was caused by the intake of the "anti-smoking" herbs, since all other causes of atrioventricular conduction disturbances were excluded. To our knowledge, our case represents the first report of atrioventricular block caused by herb intake. Given the wide consumption of herbs for various purposes and the fact that most patients are unaware of the potential risks, our case emphasizes the need for stricter regulation of such remedies.
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References |
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[1] Lord GM, Tagore R, Cook T, Gower P, Pusey CD. Nephropathy caused by Chinese herbs in the UK. Lancet 1999; 354: 481–482.[CrossRef][Web of Science][Medline]
[2] Koo HN, Hong SH, Song BK, Kim CH, Yoo YH, Kim HM. Taraxacum officinale induces cytotoxicity through TNF-alpha and IL-1alpha secretion in Hep G2 cells. Life Sci 2004; 74: 1149–1157.[Medline]
[3] Akesson C, Lindgren H, Pero RW, Leanderson T, Ivars F. An extract of Uncaria tomentosa inhibiting cell division and NF-kappa B activity without inducing cell death. Int Immunopharmacol 2003; 3: 1889–1900.[Medline]
[4] de Sousa AC, Alviano DS, Blank AF, Alves PB, Alviano CS, Gattass CR. Melissa officinalis L. essential oil: antitumoral and antioxidant activities. J Pharm Pharmacol 2004; 56: 677–681.[Medline]
[5] Do Monte FH, dos Santos JG Jr., Russi M, Lanziotti VM, Leal LK, Cunha GM. Antinociceptive and anti-inflammatory properties of the hydroalcoholic extract of stems from Equisetum arvense L. in mice. Pharmacol Res 2004; 49: 239–243.[Medline]
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