Cardiac Toxicity in Yellow Oleander (Kaner) Poisoning

Background: Yellow oleander is an ornamental plant that is common throughout tropics. Ingestion of its seeds results in a clinical picture similar to that of digoxin overdose.

Objective: To study the clinical profile of patients ingesting yellow oleander seeds and to evaluate cardiac toxicity in them.

Material and Methods: 50 patients with history of yellow oleander ingestion who were admitted in Department of Medicine, Shyam Shah Medical College and associated Sanjay Gandhi Memorial Hospital, Rewa were studied prospectively in the duration May 2009 to September 2011. Cardiac toxicity was determined by electrocardiography and echocardiography.

Results: Majority (76%) patients were females and from low socioeconomic strata. Most of patients (52%) were young in the age group 21-30 years. Vomiting was most common symptom. We observed mortality rate of 2%. The number of seeds swallowed varied from 1 to 10 and there was no simple correlation between number of seeds ingested and clinical outcome. Sinus bradycardia was most common (56%) ECG abnormality. SA block and AV block were observed in 12% and 28% cases respectively. ST-T changes were present in 60% of cases. Most of these ECG changes were reversible. Echocardiography revealed diastolic dysfunction in 20% cases.

Conclusion: The cardiac toxicity of yellow oleander poisoning was usually in the form of conduction defects affecting the sinus or AV node and ST-T changes. Most of these ECG abnormalities were reversible. Arrhythmias typical of digitalis toxicity were rare while arrhythmias rare with digitalis toxicity (Mobitz type 2 AV block) were common. Diastolic dysfunction was most common echocardiographic abnormality.