title: ST-segment elevation and ventricular tachycardia after ingestion of a common ornamental plant-a case report.
abstract: Japanese yew is a widely used ornamental plant. However, most people are unaware that it is also a poisonous plant. It has potent cardiac toxicities that can lead to sudden cardiac death. A 37-year-old female patient presented to the emergency room with altered mental status and sustained ventricular tachycardia (VT). Electrocardiogram (ECG) after cardioversion showed profound QRS prolongation and ST-segment elevation suggestive of either hyperkalaemia, acute myocardial ischaemia, or Brugada syndrome. Her electrolytes and coronary angiography were normal. After improvement of the patient's mental status, she admitted that she has been consuming Japanese yew from her yard for several months. Few hours later, QRS duration normalised, but mild ST-segment elevation persisted in the right pre-cordial leads, making it more suspicious for Brugada syndrome. However, a procainamide challenge test and electrophysiology study failed to induce typical Brugada pattern ECG and VT. The absence of coronary artery disease and electrolytes disturbances points toward the fact that her arrhythmia and ECG changes are secondary to yew intoxication. The patient was monitored for a few days. She was haemodynamically stable and has not had any arrhythmia. This case highlights the importance of public awareness of severe toxicity from Japanese yew or other yew plants. Yews contain taxines that are responsible for the ECG abnormalities due to its inhibitory effect on the cardiac sodium and calcium channels. They cause conduction abnormalities, VT, and ST-segment elevation that can resemble acute myocardial infarction, hyperkalaemia, and Brugada syndrome.
authors.affiliation: Department of Internal Medicine, KU School of Medicine, Wichita, KS, USA. dr-r-jambeih@hotmail.com
authors.forename: Rami A
authors.initials: RA
authors.lastname: Jambeih
authors.forename: Wassim H
authors.initials: WH
authors.lastname: Shaheen
authors.forename: Vuy Y
authors.initials: VY
authors.lastname: Li
authors.forename: Mazen H
authors.initials: MH
authors.lastname: Shaheen
mesh_terms: D000328:Adult; D053840:Brugada Syndrome / Q000175:diagnosis; D003937:Diagnosis, Differential; D004554:Electric Countershock; D004562:Electrocardiography; D022062:Electrophysiologic Techniques, Cardiac; D005260:Female; D006801:Humans; D010939:Plant Poisoning / Q000175:diagnosis*; D017180:Tachycardia, Ventricular / Q000209:etiology* / Q000628:therapy; D020946:Taxus