Ventricular Tachycardia After Ingestion of Ayurveda Herbal Antidiarrheal Medication Containing Aconitum

Abstract

Ayurveda is an East Indian tradition involving the treatment of medical ailments through the use of herbal medications. A previously asymptomatic 62-year-old man with a history of hypertension and stable coronary artery disease developed paresthesias and fascicular and ventricular tachycardia after ingestion of an Ayurveda bowel regimen containing substrates from the Aconitum species, which is a known neurotoxin and cardiotoxin. Findings of electrophysiologic study and cardiac magnetic resonance imaging were within normal limits, pointing to the ingestion of Aconitum as the most likely source of his arrhythmia.

The growing use of herbal medicines: issues relating to adverse reactions and challenges in monitoring safety

“…Poisoning due to homemade medicated liquor containing aconite and traditional medicine containing A. carmichaeli were reported in China between 1999 and 2008 (Liu et al, 2011). Severe cases of cardiac toxicity from consumption of aconitine-containing herbal preparation manifesting as ventricular tachycardia and fibrillation and eventually leading to death have been reported (Tai et al, 1992; Fujita et al, 2007; Dhesi et al, 2010; Lin et al, 2011). In other studies bradycardia and hypotension were observed (Chan, 2009).…”

Spectrum of cardiac manifestations from aconitine poisoning

“…The use of aconite root for medicinal purposes is common in the Hmong, Asian, and Indian populations to treat various ailments, including heartburn and headache 1 . Raw aconite roots are extremely toxic and must be processed to reduce the alkaloid content before use.…”

“…Aconitine binds with high affinity to the voltage-sensitive sodium channel in its open state and suppresses the conformational change to the inactive state, 4 delaying repolarization by prolonging sodium influx and membrane depolarization. Conformational changes to the channel induced by aconitine binding shift the activation threshold of the channel to a more negative potential, 2 while the inactivation curve is shifted toward a more positive potential, resulting in prolonged opening of the channel that predisposes to the development and persistence of triggered activity 1 …”

“…In addition, the powerful increase in late sodium channel current owing to delayed sodium channel inactivation promotes conditions for early afterdepolarization development by prolonging depolarization, as well as activation of the sodium-calcium exchanger generating a transient inward current and development of delayed afterdepolarization; 1 thus, aconitine-induced triggered activity is related to increased late I Na .…”

Review: DNA Barcoding and Chromatography Fingerprints for the Authentication of Botanicals in Herbal Medicinal Products

“…In traditional Chinese medicine (TCM) practices, aconitine has been effectively used to treat various ailments despite their toxic effects. Such effects were related to that causing ventricular tachycardia [25], bradycardia, and hypotension [26]. …”