# From Nature to Emergency: Cardiac Complications Following the Consumption of Unwashed Fruit

## TL;DR

A man experienced severe heart issues after eating unwashed Ziziphus spina-Christi fruit, possibly due to toxicity or pesticide exposure.

## Contribution

This case highlights the potential cardiotoxic effects of unwashed Z. spina-Christi fruit and pesticide exposure.

## Key findings

- A 25-year-old male developed bradycardia and hypotension after consuming unwashed Z. spina-Christi fruit.
- Cardiac evaluations ruled out ischemic or structural causes, suggesting toxicity as the likely cause.
- The patient recovered with supportive care, indicating reversible cardiotoxic effects.

## Abstract

Ziziphus spina-Christi (Sidr) is widely used for its medicinal and nutritional properties, with documented pharmacological effects such as antidiabetic, sedative, and antihypertensive activities. However, its consumption, especially in unregulated settings, can pose significant health risks due to potential toxicity and contamination with pesticides. We report the case of a 25-year-old male who presented with severe abdominal pain radiating to the chest, profound bradycardia (heart rate in the 20s), hypotension (systolic blood pressure in the 50s), and autonomic symptoms after ingesting unwashed Z. spina-Christi fruit. Initial investigations revealed Mobitz type I second-degree atrioventricular (AV) block, transient ST depression, and elevated troponin levels, raising suspicion of acute coronary syndrome (ACS). However, comprehensive cardiac evaluations, including CT coronary angiography and cardiac MRI, excluded ischemic and structural cardiac causes. A detailed history revealed the ingestion of unwashed fruit, suggesting toxicity exacerbated by pesticide exposure. The patient responded well to supportive care, including atropine, and was discharged on the fourth day with a complete resolution of symptoms. This case highlights the diagnostic challenge posed by toxic ingestions mimicking ACS. Although it is not clear if Z. spina-Christi induced cardiotoxic effects at higher doses, the pesticide contamination could have also contributed to cardiotoxicity. Clinicians should consider toxicological etiologies in patients presenting with atypical gastrointestinal and cardiovascular symptoms, especially when linked to potential exposures. Early recognition and prompt management are critical for favorable outcomes.