Welkom bij THIM Hogeschool voor Fysiotherapie & Bohn Stafleu van Loghum
THIM Hogeschool voor Fysiotherapie heeft ervoor gezorgd dat je Mijn BSL eenvoudig en snel kunt raadplegen. Je kunt je links eenvoudig registreren. Met deze gegevens kun je thuis, of waar ook ter wereld toegang krijgen tot Mijn BSL. Heb je een vraag, neem dan contact op met helpdesk@thim.nl.
Om ook buiten de locaties van THIM, thuis bijvoorbeeld, van Mijn BSL gebruik te kunnen maken, moet je jezelf eenmalig registreren. Dit kan alleen vanaf een computer op een van de locaties van THIM.
Eenmaal geregistreerd kun je thuis of waar ook ter wereld onbeperkt toegang krijgen tot Mijn BSL.
Login
Als u al geregistreerd bent, hoeft u alleen maar in te loggen om onbeperkt toegang te krijgen tot Mijn BSL.
The electrocardiogram shows bradycardia with an extreme cardiac axis deviation and severe conduction disorders, including a right bundle branch block (RBBB)-like QRS configuration with the QRS continuing into the T wave, and absence of the ST segment, mimicking a “dying heart” phenomenon [1]. Differential diagnosis comprises (1) sodium (Na+) channel blockade due to intoxication with Na+ channel blockers (e.g. flecainide or tricyclic antidepressants), or hyperkalaemia; (2) elevated intracranial pressure; or (3) primary structural heart disease. Laboratory tests revealed hyponatraemia (131 mmol/l, normal value 135–145 mmol/l) and normal levels of potassium (4.4 mmol/l, normal value 3.4–4.9 mmol/l) and other electrolytes. Toxicology results were negative, and computed tomography showed no intracranial bleeding. Echocardiography indicated normal cardiac function despite an abnormal contraction pattern due to RBBB. The patient was transferred to the intensive care unit (ICU) for monitoring and haemodynamic support. Following rapid neurological recovery within hours, subsequent anamnesis revealed that the patient had impulsively attempted suicide by preparing a smoothie using berries and leaves from a yew tree (Taxus baccata).
The toxic effects of the yew tree have been known since ancient times. Its bradyarrhythmic and tachyarrhythmic effects are attributed to blockage of fast cardiac sodium channels and calcium channels [2]. Ingestion of Taxus plant material, whether deliberately or unintentionally, often results in fatality [3]. No effective antidote currently exists, so treatment is primarily supportive.
Our patient recovered spontaneously during the ICU stay, and vasopressors were discontinued within 6 h of hospital admission. The ECG conduction disturbances returned to normal within 12 h (Fig. 1), and the patient was discharged to the psychiatric ward for further psychological support.
Fig. 1
Electrocardiogram at discharge (25 mm/s, 10 mm/mV)
×
Conflict of interest
A. van Veelen, J. Elias, P.G. Postema and M.C. van de Veerdonk declare that they have no competing interests.
Open Access This article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if changes were made. The images or other third party material in this article are included in the article’s Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article’s Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this licence, visit http://creativecommons.org/licenses/by/4.0/.
Het Netherlands Heart Journal wordt uitgegeven in samenwerking met de Nederlandse Vereniging voor Cardiologie. Het tijdschrift is Engelstalig en wordt gratis beschikbaa ...
