Salade malade: malignant ventricular arrhythmias due to an accidental intoxication with Aconitum napellus

Abstract

Intoxication with Aconitum napellus is rare in our regions. Aconite alkaloids can cause ventricular arrhythmia by a prolonged activation of sodium channels. Because the margin of safety is low between the analgesic and toxic dose, intoxication is not rare when Aconite is used in herbal medicine. We present a case in which a 39-year-old male was accidentally intoxicated with Aconite. Even though no antidote or adequate therapy is available he was successfully resuscitated. (Neth Heart J 2008;16:96-9.).

Keywords: aconite; aconitum; cardiotoxic; intoxication; resuscitation.

Figure 1A

Aconite with its bluish purple flowers, note that the shape of the flower resembles a Monk’s hood.

Figure 1B

Aconite when it is not yet flowering. Our patient ate the herb when it was in this stage; he assumed it was celery.

Figure 2

ECG upon arrival at our emergency department. The ECG shows a monomorphic ventricular tachycardia with a frequency of 220 beats/min. QRS complexes have an extreme axis of 180° and a right bundle branch block morphology. There is ‘left rabbit ear’ pattern in lead V₁ and the R/S ratio in lead V₆ is smaller than one.

Figure 3

ECG shortly after successful resuscitation. The ECG shows a supraventricular rhythm, presumably not a sinus rhythm. Polymorphic ventricular complexes can be identified both isolated and in bigeminy. They exhibit R on T phenomenon. In addition two runs of polymorphic ventricular complexes can be seen.