Abstract 17593: Betel Quid Addiction Causing Monomorphic Ventricular Tachycardia

Abstract

A 44-year-old woman presented to the emergency room due to worsening shortness of breath over the past few days with accompanying dizziness, cough, and fever. Her history was significant for asthma, obstructive sleep apnea, and hypertension. Upon arrival, she was noted to be hypoxic on room air and required supplemental oxygen. Physical exam showed extensive pitting edema in the lower extremities and crackles in bilateral lung fields. Chest radiograph revealed an enlarged cardiac silhouette and increased interstitial infiltrates consistent with pulmonary edema. While in the emergency department she was noted to have frequent episodes of asymptomatic non-sustained monomorphic ventricular tachycardia. Further questioning revealed the patient had been using betel quid daily for over 20 years to improve her mood and energy levels. She had attempted to quit in the past but was unable to do so. Echocardiogram was performed which showed preserved left ventricular function and severely dilated right ventricle. BNP was elevated at 1930 pg/mL. Due to her ventricular arrhythmias and cardiomyopathy, coronary angiography was performed; this was negative for epicardial coronary artery obstruction. Case was discussed with electrophysiology who determined the arrhythmias were likely caused by the extensive betel quid consumption. She was placed on beta-blockers and betel quid cessation was strongly recommended. Betel quid is a chewing product made from of areca nut, betel leaf, slaked lime, with or without tobacco. It is commonly used in the tropical Pacific, Asia, and parts of East Africa, and is the fourth most widely consumed addictive substances in the world due to its ability to increase alertness and produce mild euphoria. Adverse effects of betel quid include tachycardia, hyperlipidemia, metabolic syndrome, hepatotoxicity, and it is a known carcinogen. The active compound is arecoline, which acts as a parasympathomimetic on muscarinic and cholinergic receptors, increasing the central sympathetic response and producing tachycardia. Betel quid has been shown to produce ventricular arrhythmias in patients with underlying cardiomyopathy, which is likely what occurred in our patient. Betel quid cessation therefore advised in these patients.