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
Dizziness
CARDIAC MENIFESTATIONS:
Bradycardia (up to 20bpm)
Heart block
Extra-systoles
Fibrillation (ventricular)
Precordial oppression
Shallow / sighing respirations
Drowsiness
Coma
Convulsions (prelude to death)

FATAL DOSE:
15 30 mg (Digitalin)
4 mg (Digitoxin)

FATAL PERIOD:
30 min 24 hrs

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

WHITEOLEANDER
OLEANDER (KANER)
WHITE
(KANER)
NERIN (Active
principle) composed of:
NERIODORIN
cardiac failure)

(causes

NERIODOREIN

(causes
muscle twitching & tetanic
spasms)

KARABIN
spinal cord)

(acts on heart &

NERIUM ODORUM
SIGNS & SYMPTOMS

Vomiting
Abdominal pain
Frothy salivation
Restlessness
Slow & weak pulse
Hurried respirations
Dysphagia
Lockjaw
Muscular twitching
Tetanic spasms (unilateral
mostly)
Exhaustion
Drowsiness
coma
Heart failure

FATAL DOSE:
15 gms of root
FATAL PERIOD:
24 hrs

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
15 20 gms
FATAL PERIOD:
24 hrs

5% of glucose solution with

1.2 mg of atropine
2ml of adrenaline (1:1000)
2 mg noradrenalin (for
heart block)

YELLOW OLEANDER
PM APPEARNACE:
Signs of GIT irritation
Congestion of various
organs
Engorgement of veins
Subendocardial
ecchymoses
Can be detected in
exhumed putrified
bodies

MEDICOLEGAL
ASPECTS:
Suicidal poison (roots
& seeds)
Abortion
Cattle poisoning

ACONITE
(MITHA ZAHER) MITHA VISH

ACONITE
SIGNS & SYMPTOMS

Immediate tingling
Numbness
Salivation
Nausea, vomiting,
diarrhea
Drowsiness
Impaired vision & speech
Weak limbs
Muscle twitching
Convulsions

Slow & irregular pulse

Collapse
Rapid first then shallow
breathing
Alternate pupil
contraction & dilatation
(finally dilatation)
Arrhythmias
Respiratory paralysis

ACONITE
TREATMENT:
FATAL DOSE:

1 gm (root)
250 mg (extract)
25 drops (tincture)
4 mg (alkaloid)

FATAL PERIOD:
6 hours

Gastric lavage (tannic

acid)
Atropine (1 mg
hypodermic)
Digitalin (0.25 mg)
50 ml of 0.1% Novocaine
(slow IV)
Oxygen
Artificial respiration
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