Objective: It was the aim of this study to report an aborted cardiac arrest due to ventricular fibrillation and electrocardiographic changes consistent with Brugada syndrome due to liquorice-induced hypokalemia. Clinical Presentation and Intervention: Ventricular fibrillation was witnessed in a 50-year-old woman who was admitted to our emergency department with a history of liquorice ingestion, a herbal product. After stopping liquorice ingestion, the Brugada-like electrocardiographic pattern changed progressively with potassium replacement. A diagnosis of Brugada syndrome was made after the ajmaline challenge test. The patient was discharged with an implantable cardioverter defibrillator and had an uneventfull follow-up. Conclusion: This report illustrates the importance of the investigation for herbal medications in the detailed history of a patient in the cases of electrolyte disturbances and the potential role of hypokalemia in the induction of malignant arrhythmia in Brugada syndrome.
© 2010 S. Karger AG, Basel
- Brugada syndrome
- Cardiac arrest
- Brugada P: Brugada syndrome: an electrocardiographic diagnosis not to be missed. Heart 2000;84:1–2.
- Araki T, Konno T, Itoh H, Ino H, Shimizu M: Brugada syndrome with ventricular tachycardia and fibrillation related to hypokalemia. Circ J 2003;67:93–95.
- Veltmann C, Borggrefe M, Schimpf R, Wolpert C: Images in cardiovascular medicine. Yew causes Brugada ECG. Circulation 2009;119:1836–1837.
- Rouleau F, Asfar P, Boulet S, Dube L, Dupuis JM, Alquier P, Vicor J: Transient ST segment elevation in right precordial leads induced by psychotropic drugs: relationship to the Brugada syndrome. J Cardiovasc Electrophysiol 2001;12:61–65.
- Brugada P, Brugada J: Right bundle branch block, persistent ST segment elevation and sudden cardiac death: a distinct clinical and electrocardiographic syndrome. A multicenter report. J Am Coll Cardiol 1992;20:1391–1396.
- Antzelevitch C: The Brugada syndrome: diagnostic criteria and cellular mechanisms. Eur Heart J 2001;22:356–363.
- Stewart PM, Wallace AM, Valentino R, Burt D, Shackleton CH, Edwards CR: Mineralocorticoid activity of liquorice: 11-beta- hydroxysteroid dehydrogenase deficiency comes of age. Lancet 1987;ii:821–824.
- Sigurjonsdottir HA, Manhem K, Axelson M, Wallerstedt S: Subjects with essential hypertension are more sensitive to the inhibition of 11 beta-HSD by liquorice. J Hum Hypertens 2003;17:125–131.
- Krähenbühl S, Hasler F, Frey BM, Frey FJ, Brenneisen R, Krapf R: Kinetics and dynamics of orally administered 18 beta-glycyrrhetinic acid in humans. J Clin Endocrinol Metab 1994;78:581–585.
- Sigurjonsdottir HA, Franzson L, Manhem K, Ragnarsson J, Sigurdsson G, Wallerstedt S: Liquorice-induced rise in blood pressure: a linear dose response relationship. J Hum Hypertens 2001;15:549–552.
- Clyburn EB, DiPette DJ: Hypertension induced by drugs and other substances. Semin Nephrol 1995;15:72–86.
- Helfant RH: Hypokalemia and arrhythmias. Am J Med 1986;80:13–22.
- Notarstefano P, Pratola C, Toselli T, Ferrari R: Atrial fibrillation and recurrent ventricular fibrillation during hypokalemia in Brugada syndrome. Pacing Clin Electrophysiol 2005;28:1350–1353.
Hikmet Yorgun, MD
Department of Cardiology
Hacettepe University Faculty of Medicine
TR–06100 Sıhhıye, Ankara (Turkey)
Tel. +90 312 305 1780, Fax +90 312 305 4137, E-Mail email@example.com
Received: December 15, 2009
Revised: April 6, 2010
Published online: September 28, 2010
Number of Print Pages : 5
Number of Figures : 3, Number of Tables : 0, Number of References : 13
Medical Principles and Practice (International Journal of the Kuwait University Health Sciences Centre)
Vol. 19, No. 6, Year 2010 (Cover Date: September 2010)
Journal Editor: Owunwanne A. (Kuwait)
ISSN: 1011-7571 (Print), eISSN: 1423-0151 (Online)
For additional information: http://www.karger.com/MPP
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