taxine and Bradycardia

Topics: Adult; Alkaloids; Bradycardia; Diagnosis, Differential; Diagnostic Imaging; Electrocardiography; Female; Hemodynamics; Humans; Taxoids

Yew (Taxus baccata) is a conifer known to be toxic since ancient times. Taxine A and taxine B, the toxic alkaloids of Taxus, block cardiac sodium and calcium channels causing nausea, vomiting, abdominal pain, cardiac arrhythmias, respiratory distress, coma, seizures, and death in yew poisoning.. A 44-year-old male farmer was admitted to the hospital because of a suspected myocardial infarction. First bradycardia and then ventricular tachycardia were present and a severe right ventricular dilatation with biventricular dysfunction was observed but with normal coronary arteriography. He was resistant to conventional therapy and, 6 h after hospital admission, extracorporeal support with membrane oxygenation was applied. The patient recovered. Nine days later, a large number of yew leaves were unexpectedly observed in his feces. Botanical and laboratory analysis confirmed the poisoning. Blood (651 ng/mL) and urinary (5.6 mcg/mL) levels of 3,5-dimethoxyphenol (metabolite of taxicatine) were greater than previously reported in lethal cases. The patient was transferred to a psychiatric unit 17 days after admission.. Intensive treatment of severe cardiovascular symptoms with antiarrhythmic drugs, temporary pacemaker, intra-aortic balloon pump, extracorporeal membrane oxygenation, and extracorporeal life support can be life-saving even after a potentially lethal ingestion of T. baccata leaves.

Topics: Adult; Alkaloids; Anti-Arrhythmia Agents; Bradycardia; Extracorporeal Membrane Oxygenation; Foodborne Diseases; Heart-Assist Devices; Humans; Male; Phloroglucinol; Plant Leaves; Plant Poisoning; Seizures; Tachycardia, Ventricular; Taxaceae; Taxoids; Taxus