In our medical case today, we will be looking at a what happened to a patient, as documented in a paper released in July 12, 2016. It is a medical condition that has to do with how a seemingly healthy food became a nightmare.
It all started with an ordinary day. A couple sat down for lunch after preparing a wholesome kale salad. Little did they know that this seemingly innocent lunch would soon take a dark and unexpected turn. After finishing their meal, they decided to spend some quality time with their beloved pet. However, their joyous afternoon would soon be overshadowed by a series of alarming health issues.
This case began after a couple finished lunch and went to play with their pet, only for the wife to begin to feel weakness and fatigue. She tried to be strong but then noticed that her pulse was slow and irregular. As usual, just like any other person we would expect that the symptom would go away. She decided to rest instead of play with her husband but hours later she began to feel pressure in her chest, as well as abdominal cramps. Soon she experienced nausea and vomiting, and it didn't go away after a while, it was persistent.
The first thought from her was food poisoning, but then she believed she had eaten the same thing with her husband and if he is fine, then she should as well, so she erased the thoughts of food poisoning. She was in the house without treatment but overtime, her husband was able to convince her to go to the hospital and so she presented to the hospital with her symptoms but clamored on the chest pain.
When patients arrive at the hospital with chest pain, medical practitioners could predict causes such as Myocardial ischemia, Arrhythmia, Pericarditis, Aortic Dissection, Pulmonary Embolism, Tension Pneumothorax, or Esophageal rupture but they will not tell the patient that they got any of these without confirming first. With vitals, it was visible that the patient's blood pressure was normal, but her heart rate was slow showing bradycardia at a rate of 53 beats/min. Without symptoms, this heart rate can be normal but with symptoms, it can be wrong.
With this, we could pick a heart attack following that she is having chest pressure and nausea, but then there need to be a blood test to check her troponin level which should show stress or damage to the heart muscle but for the patient, her troponin level was normal, which means that it would likely not be a heart attack but since that is not all that is needed to be checked, there is still a possibility. With an electrocardiogram (ECG), we could get a clearer understanding. ECG showed sinus rhythm with first-degree atrioventricular block and sinus pauses of one to two seconds which wasn't normal.
The patient's blood work didn't show signs of pneumonia, blood clot, aortic dissection, but since the ECG wasn't good, she was redirected to a cardiologist and further scans and test showed that she had a blockage in the electrical conduction of the heart. A first-degree atrioventricular block can be as a result of Increased Vagal tone, ischemic heart disease, Infiltrative Cardiomyopathy, Hypertropic cardiomyopathy, Myocarditis, High potassium among others. Since she wasn't using any supplements, then we could rule that out, also since her blood work was quite normal, high potassium and thyroid disease can be ruled out. Since she have a normal troponin level, it is unlikely for her to have myocarditis.
With a coronary angiogram there was still nothing to show since she had no coronary artery disease. With this, a doctor might keep Sarcoidosis as an option. Sarcoidosis is the inflammatory disease as a result of an over active immune system where there are granulomas which can be anywhere in the body but mostly in the heart but this cannot be agreed upon unless confirmed via tests and scans. The patient then went into ventricular tachycardia but then the doctor was able to save her. In other to confirm Sarcoidosis, a cardiac MRI or PET scan needs to be done.
3 days after her husband presented with the similar symptoms which she had experienced. So the doctors began to check similarity and then they came to a conclusion that they might be suffering from a toxin. They had prepared for themselves Kale Salad before she began to feel those symptoms. Digoxin, when ingested in excess, can be highly toxic, leading to heart block. In their case, the husband's digoxin level was 0.3nmol/L, while the wife's was 0.4nmol/L, both in the toxic range. So on investigation of the plant which was said to be kale, it wasn't kale rather it was Fox Glove which is the plant where digoxin medication is made from. The treatment of choice, Digibind, was administered to bind with the digoxin and render it inactive.
The journey of this couple serves as a stark reminder that dangers can lurk in the most unexpected places, even in what seems to be a harmless meal. Quick thinking by medical professionals and a profound understanding of symptoms led to their diagnosis and recovery. This medical case underscores the importance of seeking immediate medical attention when unusual symptoms appear, even when the cause is not immediately clear.
Reference Reading
https://www.cmaj.ca/content/188/10/747
https://www.ncbi.nlm.nih.gov/books/NBK556025/
https://reference.medscape.com/drug/digibind-digifab-digoxin-immune-fab-antidote-343725
https://www.lung.org/lung-health-diseases/lung-disease-lookup/sarcoidosis/learn-about-sarcoidosis
Image Reference
Image 1 || pxhere || A motion blurred photograph of a patient on stretcher
Image 2 || Flickr || Heart attack concept, woman suffering from chest pain