Cimicifuga racemosa, better known as black cohosh, has been widely used in Western cultures as a herbal treatment for relieving symptoms of menopause. It has previously been linked to cases of liver toxicity. We report a case of reversible complete heart block in a woman who had recently begun taking a herbal supplement containing black cohosh. We review the known side effect profile of black cohosh and its relationship to our case.
In April 2009, a 59-year-old woman presented to a hospital emergency department after experiencing three episodes of syncope. She had never experienced cardiac ischaemic symptoms and there was no identifiable precipitant for a vasovagal event. She had no history of thyroid disease, hypertension, hyperlipidaemia or diabetes. Her personal and family medical histories were unremarkable, and she was a lifelong non-smoker and non-drinker. She had no recent febrile illness. She took no regular medications, but 2 weeks earlier had commenced taking one tablet daily of Remifemin (Schaper & Brümmer, Salzgitter, Germany; distributed by SciNat Australia, Gold Coast, Qld), a herbal preparation for the alleviation of menopausal symptoms.
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