Herbal Aconite Tea and Refractory Ventricular Tachycardia

Abstract

Recently, a patient presented to our emergency department with severe poisoning after ingesting an aconite-containing tea with therapeutic intent. Her course highlights the potentially great danger of ingesting such a preparation. The patient, a 66-year-old woman without known cardiac disease, obtained the herb for treatment of her osteoarthritis from a local herbalist, who instructed her to prepare it by making a tea. Approximately 90 minutes after ingestion of the tea, facial and extremity paresthesias developed, after which nausea, generalized weakness, and chest pressure rapidly developed. On arrival at our emergency department, she was found to have a hemodynamically compromising supraventricular tachycardia that was refractive to both administration of adenosine and electrical cardioversion. Subsequently, ventricular tachycardia developed; it had varying morphologic features (monomorphic, polymorphic, and bidirectional), was associated with periods of pulselessness, and was refractory to both electrical and various pharmacologic interventions. After approximately four hours, there was conversion to sinus rhythm, which continued until the patient was discharged as neurologically normal four days later.