Tongkat Ali-Induced Atrial Flutter: A Probable Case

Abstract

We present the case of a 71-year-old gentleman who developed new-onset atrial flutter following the initiation of Tongkat Ali (Eurycoma longifolia) supplementation. He presented with a four-day history of palpitations and dizziness. Initial workup revealed normal laboratory values, including thyroid function and electrolytes. An electrocardiogram showed supraventricular tachycardia with a heart rate of 130 bpm, which, after adenosine administration, a clear atrial flutter. Secondary causes for atrial flutter were ruled out. Given the temporal association and the absence of other predisposing factors, his atrial flutter is presumed to be Tongkat Ali-induced, representing the first documented case in the literature. This case highlights the importance of considering herbal supplements as potential triggers for cardiac arrhythmias and underscores the need for increased awareness and further research into their cardiovascular safety profiles.

Keywords: atrial flutter rapid ventricular response; herbal supplements; supra ventricular tachycardia; testosterone supplements; tongkat ali.

Figure 1. Tongkat Ali supplement label showing 668 mg extract per capsule with 2% eurycomanone content taken by the patient.

Figure 2. ECG showing supraventricular tachycardia (145 bpm, narrow QRS).

Figure 3. ECG Strip Before and After Adenosine Administration Revealing Atrial Flutter.

Figure 4. M-mode echocardiogram showing normal aortic root diameter (2.2 cm) and normal left atrial diameter (3.1 cm).

Figure 5. M-mode echocardiogram demonstrating normal left ventricular dimensions and normal function with ejection fraction of 72%.