{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,4,1]],"date-time":"2026-04-01T17:17:01Z","timestamp":1775063821146,"version":"3.50.1"},"reference-count":7,"publisher":"BMJ","content-domain":{"domain":["bmj.com"],"crossmark-restriction":true},"short-container-title":["BMJ Case Reports"],"accepted":{"date-parts":[[2016,10,5]]},"abstract":"<jats:p>A previously well woman aged 63 years presents to the emergency department with vomiting, palpitations and 3 presyncopal episodes. She had no previous medical or cardiac history, with the patient stating that she tried a herbal remedy of boiled comfrey leaves for insomnia 18\u2005hours before arrival to the department. Her ECG showed multiple abnormalities, including bradycardia, second-degree atrioventricular node block, Mobitz Type 2, a shortened QT interval, downsloping ST depression and presence of U waves. After viewing the images of comfrey and foxglove, it highlighted the possibility of mistaken ingestion of <jats:italic>Digitalis<\/jats:italic>, containing the organic forms of cardiac glycosides, such as digoxin and digitoxin. Raised serum digoxin levels confirmed this. The patient was haemodynamically stable, and given digoxin-binding antibodies. After 5\u2005days of cardiac monitoring, her ECG returned to normal rhythm, and she was discharged home.<\/jats:p>","DOI":"10.1136\/bcr-2016-216995","type":"journal-article","created":{"date-parts":[[2016,12,1]],"date-time":"2016-12-01T19:05:15Z","timestamp":1480619115000},"page":"bcr2016216995","update-policy":"https:\/\/doi.org\/10.1136\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":7,"title":["Comfrey herbal remedy causing second-degree heart block: do not be outfoxed by digitalis"],"prefix":"10.1136","volume":"2016","author":[{"given":"Mathew Kurian","family":"Vithayathil","sequence":"first","affiliation":[{"name":"Department of Accident and Emergency, King's College Hospital, London, UK"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Matthew","family":"Edwards","sequence":"additional","affiliation":[{"name":"Department of Accident and Emergency, King's College Hospital, London, UK"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"239","published-online":{"date-parts":[[2016,12,1]]},"reference":[{"key":"2025082801173429000_2016.oct19_1.bcr2016216995.1","doi-asserted-by":"publisher","DOI":"10.1309\/P024K7VRDDPJCTVN"},{"key":"2025082801173429000_2016.oct19_1.bcr2016216995.2","doi-asserted-by":"publisher","DOI":"10.1136\/hrt.54.3.258"},{"key":"2025082801173429000_2016.oct19_1.bcr2016216995.3","doi-asserted-by":"publisher","DOI":"10.1097\/MEJ.0b013e3280bef8dc"},{"key":"2025082801173429000_2016.oct19_1.bcr2016216995.4","doi-asserted-by":"publisher","DOI":"10.1016\/S1726-4901(10)70009-5"},{"key":"2025082801173429000_2016.oct19_1.bcr2016216995.5","doi-asserted-by":"publisher","DOI":"10.1016\/j.resuscitation.2007.09.001"},{"key":"2025082801173429000_2016.oct19_1.bcr2016216995.6","doi-asserted-by":"publisher","DOI":"10.1136\/bmj.290.6482.1624"},{"key":"2025082801173429000_2016.oct19_1.bcr2016216995.7","doi-asserted-by":"publisher","DOI":"10.3109\/15563650.2014.943907"}],"container-title":["BMJ Case Reports"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/syndication.highwire.org\/content\/doi\/10.1136\/bcr-2016-216995","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,8,28]],"date-time":"2025-08-28T08:17:45Z","timestamp":1756369065000},"score":1,"resource":{"primary":{"URL":"https:\/\/casereports.bmj.com\/lookup\/doi\/10.1136\/bcr-2016-216995"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2016,12,1]]},"references-count":7,"alternative-id":["10.1136\/bcr-2016-216995"],"URL":"https:\/\/doi.org\/10.1136\/bcr-2016-216995","relation":{},"ISSN":["1757-790X"],"issn-type":[{"value":"1757-790X","type":"electronic"}],"subject":[],"published":{"date-parts":[[2016,12,1]]}}}