Electrocardiographic changes during inhalational oleander toxicity
Subramanian Senthilkumaran1, Ramachandran Meenakshisundaram, Andrew D Michaels
1Sri Gokulam Hospitals and Research Institute, Salem, India. maniansenthil@yahoo.co.in
Abstract:
Inhalational oleander toxicity was considered in a family of 4 by history of exposure to smoke from burning oleander twigs. Electrocardiography revealed first- and second-degree atrioventricular block with digoxin-like ST-T-wave changes, suggestive of oleander toxicity in the absence of exposure to digoxin or other herbal medicines, and without systemic illness. Complete blood count, biometabolic profile, chest x-ray, and echocardiography did not reveal any abnormalities. Electrocardiographies normalized within 4 days when kept away from offending agents. Because oleander plant materials are used for burning, people are exposed to inhalational oleander toxicity. Hence, practitioners shall consider such poisonings in them.
Insights
Inhalational oleander toxicity can occur from burning oleander. This family experienced heart rhythm changes and ECG abnormalities, which resolved after avoiding smoke exposure.
Area of Science:
- Toxicology
- Cardiology
- Environmental Health
Background:
- Oleander (Nerium oleander) is a common ornamental plant containing cardiac glycosides.
- Burning oleander plant material releases toxic smoke, posing an inhalation risk.
- Acute toxicity can manifest with cardiovascular symptoms.
Observation:
- A family of four experienced symptoms after exposure to smoke from burning oleander twigs.
- Electrocardiography (ECG) showed first- and second-degree atrioventricular block and digoxin-like ST-T wave changes.
- No abnormalities were found in complete blood count, biometabolic profile, chest X-ray, or echocardiography.
Findings:
- The observed ECG changes were consistent with oleander toxicity, despite no exposure to digoxin or other herbal toxins.
- Symptoms and ECG abnormalities resolved within four days after cessation of exposure to the smoke.
- This case highlights inhalational exposure as a route for oleander poisoning.
Implications:
- Healthcare providers should consider inhalational oleander toxicity in patients presenting with unexplained cardiac conduction abnormalities.
- Awareness of potential toxicity from burning oleander is crucial for public health, especially in areas where it is used for fuel.
- Further research into the specific cardiac glycosides and their effects via inhalation is warranted.
Related Concept Videos
01:29Electrocardiogram
Three major waveforms are present in a typical ECG recording: the P wave, the QRS complex, and the T...
01:28Electrocardiogram Fundamentals
An electrocardiogram (ECG) is a diagnostic tool for identifying cardiac conditions such as arrhythmias, conduction abnormalities, and myocardial ischemia.
Definition
An electrocardiogram (ECG) visualizes the heart's electrical activity by tracing the electrical movement associated with each heartbeat on a graph or monitor. As the heart beats, an electrical wave passes through it, correlating with the cardiac cycle events.
Parts of an ECG
An ECG utilizes electrodes on the skin to...
01:25ECG Interpretation of Arrhythmias II: Atrial, Junctional and Ventricular Arrhythmias
01:19Acute Coronary Syndrome II: Pathophysiology and Clinical Manifestations
01:30Cardiac Action Potential
The cardiac action potential process involves a series of phases characterized by the movement of ions across the cardiac cell membranes, leading to the depolarization and repolarization of the cardiac myocytes.
Ionic Basis of Cardiac Action Potentials
01:25Correlation between ECG and Cardiac Cycle
A cardiac action potential originates in the SA node and spreads throughout the atria and the AV node in approximately 0.03 seconds. This results in the P wave in an ECG and triggers atrial contraction. The action potential is then briefly slowed at the AV node, allowing the atria to contract and fill the ventricles with blood before...