Case: Complete Heart Block Linked to BPH Dietary Supplement

WASHINGTON, DC—The use of saw palmetto was associated with complete heart block in a case presented at the ACC.17 Scientific Session. 

Saw palmetto is often used as an alternative therapy for urinary problems associated with benign prostatic hyperplasia (BPH); it is estimated that 2.5–3 million people have tried the supplement. Given that the use of complementary and alternative treatments are becoming more popular in the U.S., the authors presented this case to help improve clinician knowledge on the possible side effects associated with saw palmetto.

The patient, a 64-year-old man with a history of hypertension, type 2 diabetes, hyperlipidemia, and BPH, was brought to the emergency department (ED) after complaining of abdominal and chest pain that came on suddenly without exertion. En route to the hospital, EMS stated that patient had a heart rate in the 20s with 3rd-degree heart block which was converted to normal sinus rhythm. When he arrived in the ED, he had a heart rate in the 30s with Mobitz Type I second degree heart block. 

The cardiology team recommended transvenous pacing, which was performed and capture achieved. Work-up for acute coronary syndrome and pulmonary embolism was done but tests were negative. Laboratory results showed that lipase levels were in the 2000s, however, a CT scan of the abdomen did not suggest severe pancreatitis. 

After reviewing the patient’s medications, clinicians found that the he had started using saw palmetto for his BPH a few weeks prior. The patient was treated for pancreatitis and was advised not to use saw palmetto again. Within 2 days, his symptoms resolved and his lipase normalized. As his symptoms and CHB was thought to be due to saw palmetto, the cardiology team decided not to place a permanent pacemaker. 

While serious side effects with saw palmetto are uncommon, there have been 2 previous case reports of saw palmetto-induced pancreatitis. In this case, careful analysis of the patient’s medical history, physical, and test results helped clinicians in the decision-making process. “Waiting for the complementary medicine to be cleared from the system before placing a permanent pacemaker was crucial in this case,” they concluded.