Acute MI Following Cassia italica Ingestion 81 Cardiovascular Toxicology Humana Press Volume 6, 2006 81 *Author to whom all correspondence and reprint requests should be addressed: Ayman Ahmed El-Menyar, MD, MRCP (UK), Department of Cardiology and Cardiovascular Surgery, Hamad General Hospital, P.O. Box 3050 Doha, State of Qatar. Tel: (+974) 4392642 Fax: (+974) 4392454 E-mail: aymanco65@ yahoo.com Received: 1/11/06 Revised: 2/26/06 Accepted: 3/29/06 Cardiovascular Toxicology, vol. 6, no. 2, 81–84, 2006 Case Report Acute Myocardial Infarction With Patent Epicardial Coronary Vessels Following Cassia italica Ingestion Ayman A. El-Menyar,¹ , * Ashraf H. Helmy,¹ Nagi M. Mubarak,² and Salah E. O. Arafa¹ ¹Department of Cardiology and 2 Department of Internal Medicine, Hamad General Hospital, HMC, Doha, State of Qatar Cardiovascular Toxicology (2006) 06 81–84 $30.00 ISSN 1530-7905 (Print) © Copyright 2006 by Humana Press Inc. All rights of any nature whatsoever reserved. ISSN 1559-0259 (Online) Humana Press Abstract Herbal intake is escalating worldwide. To the best of our knowledge, myo- cardial infarction (MI) has not been reported following ingestion of laxative herbs in the absence of the well known risk factors for MI. We report on a 45- yr-old female patient who sustained acute inferior MI 8 h following Cassia italica ingestion. Subsequently, cardiac catheterization revealed patent coro- nary arteries. We assume that, in this case, MI may partly be related herbal ingestion. Further studies and public awareness of this complication in certain communities are needed. Index Entries: Herbal; coronary spasm; myocardial infarction; Cassia italica; senna. Case Report A 45-yr-old Qatari female patient who is normotensive, a nonsmoker, and non- diabetic. She denied drug abuse, and reported ingestion of laxative herb for the first time in her life. She had drunk a glass of boiled dried leaves of Eshriq. Eight hours after taking this laxative, she developed central chest pain associated with short- ness of breath. The pain was crushing in nature, radiating to left shoulder and the neck, and not responsive to sublingual nitrate. On physical examination, she was a well built lady and afebrile. Her blood pressure was 100/62 mmHg and her pulse was 72 beats per minute. The jugular venous pressure was normal, and the lung fields were clear. The first and second heart sounds were normal. Abdomen was soft and lax. The electrocardiogram (ECG) on arrival revealed ST-segment eleva- tion in inferior, and posterior leads with ST depression in V1-3, 1,AVL (Fig. 1A). ECG was repeated within 1 h post thrombolysis, and revealed normalization of ST- segment deviations (Fig. 1B). Cardiac enzymes were elevated: CPK (nl < 232): 50,315,425,406 CPK MB (nl < 5): 23, 37, 32, Troponin T (nl < 0.1): <0.01, 1.27 respectively, C-reactive protein (nl < 6) 5.3, erythrocyte sedimentation rate (<15) 14. Cholesterol: 4.4(nl < 5.1) triglycerides: 1.0 (borderline: 1.7–2.1), high-density lipoprotein (HDL): 1.4, and low-density lipoprotein (LDL): 2.6, fibrinogen 4.5 (normal) serum glucose 5.1 mmol, serum electrolytes and liver function tests were normal. Echocardiogram showed mildly impaired left-ventricular systolic func- tion, hypokinesia of inferior wall. The patient was admitted to coronary care unit