Commenced in January 2007
Paper Count: 30121
Acute Myocardial Infarction Associated with Ingestion of Herbal Mixtures Containing Acetylcholinesterase Inhibitors: A Case Study
Abstract:We reviewed an unusual case of a 65-year-old male taking an herbal mixture containing compounds with anticholinesterase activity for a long period of time, presented with acute my myocardial infarction and multiple organ dysfunction syndrome followed by death. Clinically, there are findings correlated with anticholinesterase activity, such as bilateral miosis, diaphoresis, vomiting and fasciculation without a history of any toxic ingestion or exposure. Gas chromatography–mass spectrometry screening studies identified the presence of thymol, anethole in the herbal extract and butylated hydroxytoluene in the blood sample. Hence, with this case report, we intend to highlight the necessity of evaluating the long-term use of the herbal mixture.
Digital Object Identifier (DOI): doi.org/10.5281/zenodo.1129880Procedia APA BibTeX Chicago EndNote Harvard JSON MLA RIS XML ISO 690 PDF Downloads 592
 Go AS, Mozaffarian D, Roger VL, Benjamin EJ, Berry JD, Borden WB, et al. Heart disease and stroke statistics--2013 update: A report from the American Heart Association. Circulation. 2013;127(1):e6-e245. Epub 2012/12/15.
 Costa LG. Current issues in organophosphate toxicology. Clinica chimica acta; international journal of clinical chemistry. 2006;366(1-2):1-13. Epub 2005/12/13.
 Vale A, Lotti M. Organophosphorus and carbamate insecticide poisoning. Handbook of clinical neurology. 2015;131:149-68. Epub 2015/11/14.
 Siegal D, Kotowycz MA, Methot M, Baranchuk A. Complete heart block following intentional carbamate ingestion. The Canadian journal of cardiology. 2009;25(8):e288-90. Epub 2009/08/12.
 Sekijima Y, Morita H, Shindo M, Okudera H, Shibata T. (A case of severe sarin poisoning in the sarin attack in Matsumoto--one-year follow-up of clinical findings, and laboratory data). Rinsho shinkeigaku = Clinical neurology. 1995;35(11):1241-5. Epub 1995/11/01.
 Yanagisawa N, Morita H, Nakajima T. Sarin experiences in Japan: acute toxicity and long-term effects. Journal of the neurological sciences. 2006;249(1):76-85. Epub 2006/09/12.
 Afshari AR, Sadeghnia HR, Mollazadeh H. A Review on Potential Mechanisms of Terminalia chebula in Alzheimer's Disease. Advances in pharmacological sciences. 2016;2016:8964849. Epub 2016/03/05.
 Barnes J, Anderson LA, Phillipson JD. Herbal Medicines: Pharmaceutical Press; 2007.
 Chizzola R, Michitsch H, Franz C. Antioxidative properties of Thymus vulgaris leaves: Comparison of different extracts and essential oil chemotypes. Journal of agricultural and food chemistry. 2008; 56(16):6897-904. Epub 2008/07/29.
 Hosseinzadeh S, Kukhdan AJ, Hosseini A, Armand R. The Application of Thymus vulgaris in Traditional and Modern Medicine: A Review. Global Journal of Pharmacology. 2015;9(3):260-6.
 Idle JR. Christmas gingerbread (Lebkuchen) and Christmas cheer--review of the potential role of mood elevating amphetamine-like compounds formed in vivo and in furno. Prague medical report. 2005;106(1):27-38. Epub 2005/07/13.
 Choe SYY, K.H. Toxicological studies of antioxidants, butylated hydroxytoluene (BHT) and butylated hydroxyanisole (BHA). Korea Advanced Inst of Science and Technology. 1982;14(3).
 Cedergreen N. Quantifying synergy: A systematic review of mixture toxicity studies within environmental toxicology. PloS one. 2014;9(5):e96580.
 Hassan AA, Abdullah SM, Khardali IA, Shaikhain GA, Oraiby ME. Evaluation of pesticides multiresidue contamination of khat leaves from Jazan region, Kingdome Saudi Arabia, using solid-phase extraction – gas chromatography/mass spectrometry. Toxicological & Environmental Chemistry. 2013;95(9):1477-83.
 Orhan I, Kartal M, Kan Y, Sener B. Activity of essential oils and individual components against acetyl- and butyryl-cholinesterase. Zeitschrift fur Naturforschung C, Journal of biosciences. 2008;63(7-8):547-53. Epub 2008/09/25.
 Hudaib M, Speroni E, Di Pietra AM, Cavrini V. GC/MS evaluation of thyme (Thymus vulgaris L.) oil composition and variations during the vegetative cycle. Journal of pharmaceutical and biomedical analysis. 2002;29(4):691-700. Epub 2002/07/03.
 Rodrigues VM, Rosa PT, Marques MO, Petenate AJ, Meireles MA. Supercritical extraction of essential oil from aniseed (Pimpinella anisum L) using CO2: solubility, kinetics, and composition data. Journal of agricultural and food chemistry. 2003;51(6):1518-23. Epub 2003/03/06.
 Bhadra S, Mukherjee PK, Kumar NS, Bandyopadhyay A. Anticholinesterase activity of standardized extract of Illicium verum Hook. f. fruits. Fitoterapia. 2011;82(3):342-6. Epub 2010/11/16.
 Jayalakshmi CP, Sharma JD. Effect of butylated hydroxyanisole (BHA) and butylated hydroxytoluene (BHT) on rat erythrocytes. Environmental research. 1986;41(1):235-8. Epub 1986/10/01.
 Jukic M, Politeo O, Maksimovic M, Milos M. In vitro acetylcholinesterase inhibitory properties of thymol, carvacrol and their derivatives thymoquinone and thymohydroquinone. Phytotherapy research: PTR. 2007;21(3):259-61. Epub 2006/12/23.
 Reiner GN, Labuckas DO, Garcia DA. Lipophilicity of some GABAergic phenols and related compounds determined by HPLC and partition coefficients in different systems. Journal of pharmaceutical and biomedical analysis. 2009;49(3):686-91. Epub 2009/02/04.
 Mcconnell WV, Davis HE. Alkylation of phenols. Google Patents; 1963.
 Segvic Klaric M, Kosalec I, Mastelic J, Pieckova E, Pepeljnak S. Antifungal activity of thyme (Thymus vulgaris L.) essential oil and thymol against moulds from damp dwellings. Letters in applied microbiology. 2007;44(1):36-42. Epub 2007/01/11.
 Iten F, Saller R, Abel G, Reichling J. Additive antimicrobial (corrected) effects of the active components of the essential oil of Thymus vulgaris--chemotype carvacrol. Planta medica. 2009;75(11):1231-6. Epub 2009/04/07.
 Laetz CA, Baldwin DH, Collier TK, Hebert V, Stark JD, Scholz NL. The synergistic toxicity of pesticide mixtures: Implications for risk assessment and the conservation of endangered Pacific salmon. Environmental health perspectives. 2009;117(3):348-53. Epub 2009/04/02.
 Pavela R. Acute toxicity and synergistic and antagonistic effects of the aromatic compounds of some essential oils against Culex quinquefasciatus Say larvae. Parasitology research. 2015;114(10):3835-53. Epub 2015/07/08.
 Koul O, Singh R, Kaur B, Kanda D. Comparative study on the behavioral response and acute toxicity of some essential oil compounds and their binary mixtures to larvae of Helicoverpa armigera, Spodoptera litura and Chilo partellus. Industrial Crops and Products. 2013;49:428-36.
 Karasu-Minareci E, Gunay N, Minareci K, Sadan G, Ozbey G. What may be happen after an organophosphate exposure: Acute myocardial infarction? Journal of forensic and legal medicine. 2012;19(2):94-6. Epub 2012/01/28.
 Soares PM, Lima RF, de Freitas Pires A, Souza EP, Assreuy AM, Criddle DN. Effects of anethole and structural analogues on the contractility of rat isolated aorta: Involvement of voltage-dependent Ca2+-channels. Life sciences. 2007;81(13):1085-93. Epub 2007/09/18.
 de Siqueira RJ, Magalhaes PJ, Leal-Cardoso JH, Duarte GP, Lahlou S. Cardiovascular effects of the essential oil of Croton zehntneri leaves and its main constituents, anethole and estragole, in normotensive conscious rats. Life sciences. 2006;78(20):2365-72. Epub 2005/12/06.
 Szentandrassy N, Szigeti G, Szegedi C, Sarkozi S, Magyar J, Banyasz T, et al. Effect of thymol on calcium handling in mammalian ventricular myocardium. Life sciences. 2004;74(7):909-21. Epub 2003/12/09.
 Magyar J, Szentandrassy N, Banyasz T, Fulop L, Varro A, Nanasi PP. Effects of thymol on calcium and potassium currents in canine and human ventricular cardiomyocytes. British journal of pharmacology. 2002;136(2):330-8. Epub 2002/05/16.
 Gad SC, Leslie SW, Acosta D. Inhibitory actions of butylated hydroxytoluene on isolated ileal, atrial, and perfused heart preparations. Toxicology and applied pharmacology. 1979;49(1):45-52. Epub 1979/06/15.
 Saheb JL, Saheb SA. Toxic effects of butylated hydroxytoluene on rats. Canadian journal of comparative medicine: Revue canadienne de medecine comparee. 1977;41(2):195-201. Epub 1977/04/01.
 Leslie SW, Gad SC, Acosta D. Cytotoxicity of butylated hydroxytoluene and butylated hydroxyanisole in cultured heart cells. Toxicology. 1978;10(3):281-9. Epub 1978/07/01.
 Lin CH, Yang JY. Chemical burn with cresol intoxication and multiple organ failure. Burns: journal of the international society for burn injuries. 1992;18(2):162-6. Epub 1992/04/01.
 Monma-Ohtaki J, Maeno Y, Nagao M, Iwasa M, Koyama H, Isobe I, et al. An autopsy case of poisoning by massive absorption of cresol a short time before death. Forensic science international. 2002;126(1):77-81. Epub 2002/04/17.