IntroductionThis report describes a case of intentional

self-harm with the use of yew leaves. The effectsof Taxus Baccata ingestion and the difficulty oftreatment are discussed.

Case ReportA 43-year-old woman with a psychiatric his-

tory was referred to the psychiatric ward with pro-gressive depression and suicidal thoughts. Tendays after admission she unexpectedly attemptedsuicide by ingesting a handful of yew leaves(Taxus Baccata) that she had found in the gardenssurrounding the hospital. She reported havingdone so, approximately 12 hours after ingestion.

She was subsequently admitted to the Emer-gency Department where she complained of se-vere fatigue with minor abdominal complaintsand nausea. On examination her blood pressurewas 80/60 mmHg and her pulse, irregular, 80beats/min. She showed no further apparent phys-ical signs or symptoms and her chest X ray wasnormal. An electrocardiogram (ECG) (Fig. 1)showed a polymorphic ventricular tachycardiawhich degenerated into ventricular fibrillation.Following electrical cardioversion extreme brady-cardia and electromechanical dissociation wasnoted. Reanimation procedures were started and atemporary pacemaker was inserted. Following ashort session of cardiopulmonary resuscitation

(CPR), the hemodynamic situation recovered anda regular sinus rhythm was restored. Although thepatient was not taking any digoxin, a lethal rise inplasma digoxin levels (. 5 ng/mL) was noted.Screening for opiates, benzodiazepines, phenoth-iazines in serum and urine was negative.

Forced diuresis and treatment with Fab-frag-ment were started. She was transferred to theCoronary Care Unit, where 24-hour ECG monitor-ing showed a regular rate and no further arrhyth-mias. The digoxin blood level progressively de-creased to reach nontoxic levels after 1 week.

Twelve days after her attempted suicide shewas transferred to a psychiatric institution for fur-ther assessment and treatment for her depressionand suicidal tendencies. One month later she onceagain intentionally ingested a larger quantity ofleaves and subsequently died of cardiogenic shockdespite immediate and intensive CPR.

DiscussionThe use of poisonous plants as a means of de-

liberate self-harm is uncommon, in spite of easyaccess and their high toxicity. Therefore, it canpresent a challenging diagnosis for the clinician.

Yew (Taxus baccata and Taxus canadensis) isa small coniferous tree (Fig. 2) widely found andused as ornamental shrubbery . Yew has long beenknown to be a poison and although all parts of theplant are toxic, the most frequent poisonings oc-cur with the ripened red berries. As these containlittle alkaloid, they are relatively harmless andproduce minor symptoms such as nausea, vomit-ing, and utricarial reactions.

The 15 yew species described in the literatureproduce extremely cardiotoxic and unstable ex-tracts.1 The pseudo-alkaloid taxine B inhibits cal-cium and sodium transport in myocardial cells

Intoxication with Taxus Baccata: CardiacArrhythmias Following Yew Leaves IngestionWILLEM WILLAERT, PHILIP CLAESSENS, BART VANKELECOM, and MARC VANDERHEYDENFrom the Department of Cardiology, Imelda Ziekenhuis, Bonheiden, Belgium

WILLAERT, W., ET AL.: Intoxication with Taxus Baccata: Cardiac Arrhythmias Following Yew Leaves In-gestion. The use of yew leaves (Taxus Baccata) as a means of deliberate self-harm is infrequent. The po-tent effect of the toxin is primarily cardiac and results in rhythm alterations and ultimately ventricularfibrillation. As there is no known antidote, and classic antiarrhythmic therapy proves to be ineffective, aprompt diagnosis is of great importance as immediate supportive action is the only valuable alternative.This case describes a 43-year-old women who attempted suicide by ingesting the leaves of Taxus Baccata.We discuss the effects and the difficulty of treatment associated with yew leaf poisoning. (PACE 2002;25[Pt. I]:511–512)

yew, taxus, poisoning, arrhythmia

PACE, Vol. 25, No. 4 April 2002, Part I 511

Address for reprints: Marc Vanderheyden, M.D., Cardiovascu-lar Center, Ziekenhuis, Moorselbaan 164, 9300 Aalst, Belgium.Fax: 0032-53-724185; e-mail: marc.Vanderheyden6skynet.be

Received February 6, 2001; revised April 16, 2001; acceptedJuly 16, 2001.

Reprinted with permission fromJOURNAL OF PACING AND CLINICAL ELECTROPHYSIOLOGY , Volume 25, No. 4, Part 1, April 2002

Copyright © 2002 by Futura Publishing Company, Inc., Armonk, NY 10504-0418.

and interferes with the heart’s conduction system,acting as a cardiac depressant. This has been pro-posed as the cause of the clinical manifestations ofyew ingestion2 although the exact mechanism bywhich the toxin exerts it’s cardiac effect is still un-clear.

Recent case reports3–6 describe a clinical pic-ture including nausea, dyspnea, abdominal pains,convulsions, coma, and eventually death, allwithin hours of ingestion. Examination often re-veals hypotension accompanied by rhythm alter-ations such as tachycardia or bradycardia. ECG ex-amination reveals characteristics of ventriculartachycardia and fibrillation with prolonged andaberrant QRS intervals.

As there is no known antidote and classic an-tiarrhythmic treatment proves to be ineffective,management of a taxus intoxication is essentiallysupportive. Earlier cases5 have hypothesized sim-ilarities in the mechanism by which yew alkaloidsand digitalis glycosides exert their arrhythmic ef-

fect and cross-reactivity between both moleculeshas been described. The patient expressed a highdigitalis blood level after the ingestion of theleaves. Therefore treatment with Fab-fragmentsmay be beneficial. Further research should con-centrate on the exact mechanism of action andpossible therapeutic options for this rare but life-threatening intoxication.

WILLAERT, ET AL.

512 April 2002, Part I PACE, Vol. 25, No. 4

Figure 2. Taxus Baccata

Figure 1. Twelve-lead electrocardiogram recorded afteradmission demonstrating polymorphic ventriculartachycardia.

References1. Witherup KM, Look MW, Stasko TTJ, et al. Taxus spp. needles

contain amounts of taxol comparable to the bark of Taxus brevifo-lia: analysis and isolation. J Nat Prod 1990; 53:1249–1255.

2. Ogden L. Taxus (yews): A highly toxic plant. Vet Hum Toxicol1988; 30:563–564.

3. Stebbing J, Simmons HL, Hepple J. Deliberate self-harm using yewleaves (Taxus baccata). Br J Clin Pract 1995; 49:101.

4. Sinn LE, Porterfield JF. Fatal taxine poisoning from yew leaf in-gestion. J Forensic Sci 1991; 36:599–601.

5. Yersin B, Frey JG, Schaller MD, et al. Fatal cardiac arrhythmias andshock following yew leaves ingestion. Ann Emerg Med 1987;16:1396–1397.

6. Janssen J, Peltenburg H. [A classical way of committing suicide:with Taxus Baccata]. Ned Tijdschr Geneeskd 1985; 129:603–605.