Japanese yew is a widely used ornamental plant. However, most people are unaware that it is also a poisonous plant. It has potent
cardiac toxicities that can lead to
sudden cardiac death. A 37-year-old female patient presented to the emergency room with altered mental status and sustained
ventricular tachycardia (VT). Electrocardiogram (ECG) after
cardioversion showed profound QRS prolongation and ST-segment elevation suggestive of either hyperkalaemia, acute myocardial ischaemia, or
Brugada syndrome. Her
electrolytes and coronary angiography were normal. After improvement of the patient's mental status, she admitted that she has been consuming Japanese yew from her yard for several months. Few hours later, QRS duration normalised, but mild ST-segment elevation persisted in the right pre-cordial leads, making it more suspicious for
Brugada syndrome. However, a
procainamide challenge test and electrophysiology study failed to induce typical Brugada pattern ECG and VT. The absence of
coronary artery disease and
electrolytes disturbances points toward the fact that her
arrhythmia and ECG changes are secondary to yew intoxication. The patient was monitored for a few days. She was haemodynamically stable and has not had any
arrhythmia. This case highlights the importance of public awareness of severe toxicity from Japanese yew or other yew plants. Yews contain taxines that are responsible for the ECG abnormalities due to its inhibitory effect on the cardiac
sodium and
calcium channels. They cause conduction abnormalities, VT, and ST-segment elevation that can resemble acute
myocardial infarction, hyperkalaemia, and
Brugada syndrome.