Holton Kenneth, Sanchez Corredera Christian, Haidar Jason, Valentin Ramon G, Perez Donny, Boccio Eric
Department of Emergency Medicine, Memorial Healthcare System, Hollywood, USA.
Department of Emergency Medicine, Nova Southeastern University Dr. Kiran C. Patel College of Osteopathic Medicine, Fort Lauderdale, USA.
Cureus. 2024 Oct 22;16(10):e72129. doi: 10.7759/cureus.72129. eCollection 2024 Oct.
Kratom denotes the naturally occurring alkaloids found in and is self-administered for the treatment of chronic pain, anxiety, and opioid withdrawal. Kratom is cardiotoxic with several case reports linking its use to QTc prolongation and ventricular dysrhythmias; however, there exist few reports of kratom-induced Brugada syndrome. A 36-year-old male with a past medical history inclusive of polysubstance abuse, bipolar disorder, and seizure disorder presented to the emergency department for chest pain. The patient reported a three-week history of lightheadedness when standing, oftentimes accompanied by palpitations and syncope. The patient was prescribed lamotrigine but reported non-adherence for more than three months due to a lack of insurance. The patient self-administered high-dose (~100 grams/day) white vein kratom daily for the last three years for symptoms of opioid withdrawal and alcohol cravings. He denied a family history of sudden cardiac death. The initial electrocardiogram (EKG) demonstrated coved ST segments followed by a negative T wave in leads V1 and V2 consistent with a type 1 Brugada pattern. Pacer pads were applied, and cardiology and electrophysiology were consulted. The patient was admitted to the medical intensive care unit on telemetry. Serial EKGs returned to normal sinus rhythm, and an inpatient flecainide challenge was negative, making Brugada syndrome secondary to chronic high-dose kratom use the most likely diagnosis. We presented a case of type 1 Brugada syndrome induced by chronic high-dose kratom use. While the clinical management of kratom toxicity is mostly supportive, physicians should consider potentially fatal cardiac dysrhythmias including Brugada syndrome.
kratom是指在[植物名称未给出]中发现的天然生物碱，人们自行服用它来治疗慢性疼痛、焦虑和阿片类药物戒断症状。kratom具有心脏毒性，有几例病例报告将其使用与QTc延长和室性心律失常联系起来；然而，关于kratom诱发Brugada综合征的报告很少。一名36岁男性，既往有多种物质滥用、双相情感障碍和癫痫病史，因胸痛就诊于急诊科。患者报告站立时头晕三周，常伴有心悸和晕厥。患者曾被处方拉莫三嗪，但因缺乏保险，报告停药超过三个月。在过去三年里，患者每天自行服用高剂量（约100克/天）的白脉kratom来缓解阿片类药物戒断症状和戒酒欲望。他否认有心脏性猝死家族史。初始心电图（EKG）显示V1和V2导联出现穹窿型ST段，随后T波倒置，符合1型Brugada图形。应用了起搏电极片，并咨询了心脏病学和电生理学科。患者被收入医疗重症监护病房进行心电监测。系列心电图恢复为正常窦性心律，住院期间氟卡尼激发试验结果为阴性，最可能的诊断是慢性高剂量使用kratom继发Brugada综合征。我们报告了一例因慢性高剂量使用kratom诱发的1型Brugada综合征病例。虽然kratom毒性的临床管理大多是支持性的，但医生应考虑包括Brugada综合征在内的潜在致命性心律失常。
