CASE REPORT

Anticholinergic Syndrome and Supraventricular Tachycardia
Caused by Lavender Tea Toxicity
Ayca Acikalin,1 Muge Gulen,1 Banu Kara, 2 Ferhat Icme, 3,4 Caglar Emre Cagliyan1 and Salim Satar1
1Adana Numune Education and Research Hospital, Department of Emergency Medicine, Adana, Turkey
2Adana Numune Education and Research Hospital, Department of Gastroenterology, Adana, Turkey

3Ankara Ataturk Education and Research Hospital, Department of Emergency Medicine, Ankara, Turkey
4Caglar Emre Cagliyan, Adana Numune Education and Research Hospital, Department of Cardiology,Adana, Turkey(Received for publication on July 11, 2011)(Revised for publication on November 4, 2011)(Accepted for publication on December 15, 2011)

Lavender plants have been used for their cosmetic and biologic benefits for many centries. Extracts from
Lavandula plants have been found to cause antimuscarinic effects by blocking sodium and calcium ion
channels in in vitro and in vivo studies. We present a case of poisoning by ingestion of tea made from
Lavender stoechas ( grass). The patient was admitted to our emergency department with supraventricular tachycardia due to anticholinergic syndrome triggered by drinking lavender tea. On electrocardiography, a narrow QRS complex tachycardia was evident. After carotid sinus massage, the patient immediately returned to sinus rhythm. There are no reported data about the toxicity of Lavender stoechas
plants with respect to supraventricular tachycardia, anticholinergic syndrome or sympathetic nerve
activity. (Keio J Med 61 (2) : 66–68, June 2012)

Keywords: emergency, lavender, supraventricular tachycardia, poisoning

Introduction

her cough. She was admitted to our emergency department with supraventricular tachycardia triggered by anticholinergic syndrome or sympathetic nerve activity,
which are frequent side effects of products made fromthese plants.

Lavender plants have been in widespread use in our daily lives since the 18th century because of their cosmetic
and biologic effects. Teas and distilled oils prepared fromplants of Lavandula spp. have been used as antibacterial,antifungal, sedative, expectorant and analgesic agents;smooth muscle relaxants; antiseptic for urinary tract infections; and for soothing burns and insect bites. Despite
the wide-ranging use of these teas and oils, their biological effects and side effects are not known in detail.1
Because alternative medical treatments and use of medicinal plants are increasing worldwide, allergic reactions
that can lead to serious poisoning are observed frequently. In this article, we present a poisoning case resulting
from the ingestion of tea made from Lavender stoechas(Buckwheat grass), which was drunk by a woman for its
antitussive and expectorant effects in an attempt to treat

Case
A 46-year-old woman was admitted to our emergency
department with palpitations and shortness of breaththat had been present for 6 h. She reported that she had
drunk buckwheat herb (Lavender stoechas) tea (Fig. 1) 7
h before admission for the treatment of her cough, which
had persisted for 1 week. Her symptoms were palpitations, shortness of breath, headache, dizziness, nausea,and epigastric pain and fever; these had started approximately 1 h after herbal tea ingestion. On admission to theemergency room, the patient’s arterial blood pressure wasReprint requests to: Salim Satar, MD, Adana Numune Education and Research Hospital, Department of Emergency Medicine, Adana 01170,Turkey, E-mail: salim.satar@yahoo.com
Copyright © 2012 by The Keio Journal of Medicine
66Keio J Med 2012; 61 (2): 66–68

Fig. 1 Buckwheat herb (Lavender stoechas).
Our patient drank tea made from these plants.

150/100 mmHg, pulse rate 164/min, temperature 38.7°C
and respiratory rate 22/min. Her Glasgow Coma Scale(GCS) score was 15 and other systemic findings werenormal. The patient’s complete blood count, biochemistry and blood gas levels were found to be in the normal
ranges. A narrow QRS complex tachycardia was foundon electrocardiography (Fig. 2). The patient was monitored, 4 L/min oxygen was started via nasal cannula andintravenous access was established. Because her fever
did not respond to cold compress application, intravenous
paracetamol was given, and this led to normalization ofbody temperature at 36.7°C. Since her tachycardia persisted despite normalization of body temperature, carotid
sinus massage was performed; this resulted in abrupt termination of the supraventricular tachycardia and maintenance of sinus rhythm. The control electrocardiographytaken after the termination of supraventricular tachycardia revealed normal sinus rhythm, and no other pathological signs were observed (Fig. 3). Control vital signs
were as follows: arterial blood pressure, 130/70 mmHg;
pulse rate, 84/min; temperature, 36.7°C; respiratory rate,
16/min. The patient was hospitalized in the observation
unit, and after 24 h of observation, no additional problems occurred and the patient was discharged with advice
to use these kinds of herbal products cautiously.
Discussion
Lavender tea and oil obtained from lavender plants
have been in general use for many centuries. Lavandula
spp. are widely used because of their biological and cosmetic properties. The most commonly used Lavandula
spp. are L. angustifolia, L. latifolia, L. stoechas and L. x
intermedia.1 The tea and oil of these plants are often usedas smooth muscle relaxants, antibacterial and antifungal
agents, and expectorants; they are also used to treat insect
bites owing to their relaxant effects.

67

Although Lavandula spp. are widely used, scientificstudies on the effects of these plants and their ingredients
have only been carried out in recent decades. The chemical constituents of Lavandula plants have been identified
by analysis of oils obtained from flowers. Essential oilsof Lavandula spp. have complex compositions made upof many different aromatic compounds. These substances
have been examined and determined by analytic techniques such as gas chromatography, mass spectrometry
and infrared spectroscopy. The main components of theseoils are linalool, linalyl acetate, 1.8 cineole, β-ocimene,
terpinene-4-ol and camphor.2
The systemic effects of the chemical constituents of Lavandula spp. may begin after contact of the skin with oils,
inhalation due to their volatile properties or the drinking of tea. Plasma levels of linalool and linalyl acetate
increase about 19 min after the oils from these plants
contact the skin.3 Linalool and linalyl acetate have narcotic and sedating effects on the central nervous system.
It is believed that these substances affect especially theamygdala and hippocampus regions of the limbic system
by increasing the effects of gamma hydroxyl butyric acidand resulting in benzodiazepine-like sedative effects.4
Antispasmodic effects of Lavandula spp. have occurredbecause of the resulting increase in intracellular cAMP.5
Lavandula spp. are also believed to have antibacterial
and antifungal effects. In in vitro studies, L. Angustifolia
oil was shown to be reactive against methicillin-resistant
Staphylococcus aureus (MRSA) and vancomycin-resistant Enterococcus faecalis (VRE) at concentrations ofless than 1%.6
Lavandula spp. contain many camphor-related substances. Those species with high camphor content arepreferred as insect repellents, whereas those with low
camphor content are preferred by the perfume industry.
L. stoechas has a high camphor content.1,7L. stoechas, also known as buckwheat herb, is widelyused in the community as an analgesic, expectorant, sedative and urinary antiseptic. The oils obtained from thisplant are preferred for topical application as antiseptic
solutions and insect repellents. The compounds found inL. stoechas include saponins, glycosides, camphor, cineol and borbor.8 Camphor levels are higher in L. stoechasthan in other Lavandula spp. Most of the dermal or systemic effects are thought to result from the high levelsof camphor. Camphor is a cyclic ketone of the hydroaromatic terpene group with a strong and aromatic scent.
Camphor is used as an antibacterial, local analgesic, inotropic agent, brain and nerve stimulant against syncope,expectorant, antitussive, cold drug and moth repellent.8
It is used today in the pharmaceutical industry as a
topical antitussive and analgesic and is a preferred anesthetic and antipruritic agent. If it is used in improper
doses, however, it can cause poisoning. Poisoning related
to Lavandula spp. may occur with gastrointestinal intake,skin contact or inhalation,8 and camphor toxicity begins

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Acikalin A, et al: Lavender and Supraventricular Tachycardia

Fig. 2 A narrow QRS tachycardia was seen on electrocardiography.

Fig. 3 Normal sinus rhythm was seen after termination of supraventricular tachycardia.

within the first hours after intake. The first signs are oral
and epigastric burning, nausea, vomiting and headache.
Other adverse effects are tachycardia, elevated liver enzymes, and central nervous system and cardiovascularsystem toxicity.9,10 The toxic effect on the central nervous
system can result in mental confusion and convulsion.
Severe poisoning can cause status epilepticus, apnea,
asystole, circulatory collapse and death.10 Serious central
nervous system toxicity related to accidental camphor exposure, especially in children, has been reported in theliterature. Camphor exhibits cardiovascular toxicity and
it is known to cause hypertension and tachycardia during
the early stage of toxicity and to cause peripheral vascular collapse and shock in serious cases. QT and prolonged QTc in electrocardiograms and acute myocarditis
due to camphor toxicity have been reported in one case in
the literature.10 Since our center was not able to measure
camphor levels, we could not determine the plasma levelin our patient.
We think that the tachycardia, hypertension and signsof high temperature seen in our patient may have resulted
from the camphor in L. stoechas plants or may have beenconsequences of either sympathomimetic or anticholinergic toxicity as well. Ghelerdani et al. showed that plantsof Lavandula spp. may cause antimuscarinic effects byblocking sodium and calcium ion channels in in vitro
and in vivo studies.9 The fever, tachycardia and signsof hypertension occurring in our patient may have been
related to antimuscarinic effects caused by inhibition ofcentral and peripheral muscarinic cholinergic nerve conduction. There are no data in the literature demonstrating
sustained arrhythmias (e.g., supraventricular tachycardia
and ventricular tachycardia) and anticholinergic symptoms triggered by L. stoechas. The patient did not drink
the herbal tea again after her recovery, so we could notobserve a direct relationship between herbal tea ingestion and arrhythmia generation. This fact diminishes theproof of our hypothesis and is the main limitation of thisarticle.

In conclusion, we reported on a patient who experienced hyperthermia, hypertension and supraventriculartachycardia after drinking a very popular kind of herbal
tea that contains L. stoechas (Buckwheat herb). The extracts of L. stoechas may show adverse antimuscariniceffects, and therefore appropriate advice should be given
to patients who have arrhythmic conditions.
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