CARDIAC POISONS

CARDIAC POISONS
Mainly affect heart function
Direct effect
Indirect effect (via nerves)

IMPORTANT CARDIAC POISONS:

Digitalis
Oleander
Aconite
Nicotine
Hydrocyanic acid
Quinine
 DIGITALIS PURPUREA
Aka DIGITALIS or purple
FOXGLOVE
SOURCE: Plant, roots,
seeds, leaves
Contains glycosides with
cumulative action

Digoxin
Digitalin
Digitalein
Digitonin
Improve function of failing
heart (therapeutic dose)
Toxic effects in large or
toxic doses
 SIGNS & SYMPTOMS
Nausea, vomiting & diarrhea
Abdominal pain
Depression
Headache FATAL DOSE:
Dizziness
CARDIAC MENIFESTATIONS: 15 30 mg (Digitalin)
Bradycardia (up to 20bpm) 4 mg (Digitoxin)
Heart block
Extra-systoles
Fibrillation (ventricular) FATAL PERIOD:
Precordial oppression
Shallow / sighing respirations
Drowsiness 30 min 24 hrs
Coma
Convulsions (prelude to death)
 TREATMENT
Stomach wash (tannic acid)
WBI (in case of plant ingestion)
Atropine 0.6 mg hypodermically (to treat bradycardia)
Potassium salts (check renal profile)
Specific Antidotes: (for arrhythmias)
Propranolol ( blocker)
Novocaine (Na+ channel blocker)
Trisodium EDTA (lowers calcium)
ECG
Symptomatic treatment
 PM APPEARANCE
Not characteristic!
Irritation of gastric
mucosa
Plant leaves or seeds
in stomach
Small, reddish brown
angular shaped seeds
with peculiar
markings
OLEANDER
(KANER)
 NERIUM
NERIUM ODORUM
ODORUM
WHITE
WHITEOLEANDER (KANER)
OLEANDER (KANER)

NERIN (Active
principle) composed of:

NERIODORIN (causes
cardiac failure)
NERIODOREIN (causes
muscle twitching & tetanic
spasms)
KARABIN (acts on heart &
spinal cord)
 NERIUM ODORUM
SIGNS & SYMPTOMS

Vomiting
Abdominal pain
FATAL DOSE:
Frothy salivation
Restlessness
Slow & weak pulse 15 gms of root
Hurried respirations
Dysphagia
Lockjaw
Muscular twitching FATAL PERIOD:
Tetanic spasms (unilateral
mostly)
Exhaustion
Drowsiness 24 hrs
coma
Heart failure
 NERIUM ODORUM
TREATMENT
Stomach wash

Symptomatic treatment

Anesthetic

Morphine
 NERIUM ODORUM
PM APPEARANCE
Non specific

Petechial
hemorrhages on heart

Can be detected in
burnt body remains
(heat resistant)
 NERIUM ODORUM
MEDICOLEGAL ASPECTS
 YELLOW OLEANDER
(CERBERA THEVETIA) PEELA KANER
Active Principles:

1. THEVETIN

2. THEVOTOXIN (less
toxic)

3. CERBERIN (strychnine
like action)
YELLOW OLEANDER
SIGNS & SYMPTOMS
 YELLOW OLEANDER
FATAL DOSE: TREATMENT:

IV Na lactate (for acidosis)

8 10 seeds
5% of glucose solution with
15 20 gms 1.2 mg of atropine

2ml of adrenaline (1:1000)

FATAL PERIOD:
2 mg noradrenalin (for
heart block)
24 hrs
 YELLOW OLEANDER
PM APPEARNACE: MEDICOLEGAL
ASPECTS:
Signs of GIT irritation
Congestion of various
Suicidal poison (roots
organs
Engorgement of veins
& seeds)
Subendocardial
ecchymoses Abortion
Can be detected in
exhumed putrified
bodies Cattle poisoning
 ACONITE
(MITHA ZAHER) MITHA VISH
 ACONITE
SIGNS & SYMPTOMS
Immediate tingling Slow & irregular pulse
Numbness Collapse
Salivation Rapid first then shallow
Nausea, vomiting, breathing
diarrhea
Alternate pupil
Drowsiness
contraction & dilatation
Impaired vision & speech
(finally dilatation)
Weak limbs
Arrhythmias
Muscle twitching
Convulsions Respiratory paralysis
 ACONITE
TREATMENT:

FATAL DOSE: Gastric lavage (tannic

acid)
1 gm (root) Atropine (1 mg
250 mg (extract) hypodermic)
25 drops (tincture) Digitalin (0.25 mg)
4 mg (alkaloid)
50 ml of 0.1% Novocaine
(slow IV)
FATAL PERIOD: Oxygen
Artificial respiration
6 hours Symptomatic treatment
 NICOTINE
(TOBACCO)
 SIGNS & SYMPTOMS
(MILD POISONING)
Owing to mild exposure or absorption
Symptoms subside soon
Dizziness
Nausea
Vomiting
Headache
Perspiration
Generalized weakness
Mild rise in blood pressure
Increased pulse rate
Palpitations
 SIGNS & SYMPTOMS
(ACUTE POISONING)
2 to nicotine absorption in toxic amounts
Burning sensation (fauces & stomach)
Symptoms of mild poisoning (rapidly)
Prostration
Convulsions
Respiratory slowing
Cardiac irregularity
Coma
Death (exhaustion, arrhythmias, respiratory
failure)
 SIGNS & SYMPTOMS
(CHRONIC POISONING)
2 to continued exposure of tobacco
Laryngitis
Chronic cough
Pharyngitis
Bronchitis dermatitis
Stains on teeth
Halitosis
Angiospasms
Muscular tremors
Amblyopia (lazy eye) decreased acuity
Blindness
Cardiac arrhythmias
Extra-systole with chest pain (angina pectoris?)
Occlusive Thromboangiitis Obliterans
Caner (mouth, throat, tongue, larynx, lungs)
Non thrombocytopenic purpura (with mentholated cigarette smoking)
 NICOTINE
FATAL DOSE:

60 mg (nicotine)
2 gms (tobacco)
1 tsf (insecticide)
1 cigarette contains 1 gm of tobacco!!

FATAL PERIOD:

Few minutes to few hours in case of swallowing

 TREATMENT
Wash with soap & water (skin contamination)
Gastric lavage (activated charcoal)
Purgative (sodium sulphate)
Monitoring cardiac function
Oxygen
Artificial respiration
Symptomatic treatment
Cessation of smoking
 PM APPEARANCES
Similar to those of asphyxia
Characteristic smell in stomach
Brown discoloration of gastric mucosa
Brownish yellow discoloration of skin
Gastric irritation
Pulmonary edema
Can be traced in putrefied body
MEDICOLEGAL ASPECTS
Addiction
Psychological dependence
Chronic disability (excessive tobacco
use)
Decreased life expectancy
Poisoning may be accidental
Absorption from skin (poultice)
Infanticide