Quinine Water-Triggered Atrial Tachyarrhythmia

Quinine is an anti-malarial drug with documented hematologic, dermatologic, and cardiovascular side effects. Tonic water contains a sub-therapeutic amount of quinine and is available over the counter. However, the public is unaware of the risks associated with excessive consumption of tonic water. We present a patient who developed atrial flutter with a rapid ventricular response following the consumption of tonic water. The patient responded to rate control therapy and was discharged the following day with a plan to follow up in the outpatient department with an electrophysiologist. Although quinine has been shown to have ventricular anti-arrhythmic effects, its effect on the atria has not been determined. We present this case to bring greater awareness to the cardiovascular risks associated with the consumption of tonic water to reduce morbidity and mortality.