Cardiovascular effects of a hallucinogenic agent (psilocybin) – presentation of a clinical case

Introduction (case reports only) Psilocybin is the active ingredient in hallucinogenic mushrooms. Mushroom poisoning has various manifestations such as tachycardia, hypertension, hyperreflexia, prolongation of the QT interval, arrhythmias, particularly in people with risk factors. We aim to assess possible cardiovascular effects of psilocybin. Case description (case reports only) A 32-year-old patient lost consciousness in her home, initial resuscitation was performed, and ambulance was called. Ventricular fibrillation (VF) was detected, and defibrillation was performed two times to restore spontaneous blood flow. In the Cardiac Intensive Care Unit (CICU) blood tests showed hypokalaemia, hypomagnesaemia, ~4 times increased parenchymal liver enzymes, D-Dimers - 1.33, TnI - 0.02. ECG and coronary angiography showed no abnormalities. It is known that patient underwent radiofrequency ablation for atrioventricular nodal re-entry tachycardia in year 2008 and 2014 and has consumed unspecified hallucinogenic mushrooms 1 day ago. After patient regained consciousness and was extubated, signs of postanoxic encephalopathy remained. Cerebral CT showed moderate cerebral oedematous lesions. Episodes of torsades de pointes (TDP) and VF were observed on days 2 and 3. Cardiac echocardiography showed a prolapse of the posterior leaflet of the mitral valve with slight leakage. A urine drug test was negative. Arrhythmias observed on days 2 and 3 could have been caused by psilocybin, but in the absence of confirmatory data, a single-chamber implantable cardioverter defibrillator (ICD) was implanted for secondary prevention of sudden death. Summary (case reports only)A woman was hospitalised after clinical death and restoration of spontaneous circulation. Several more episodes of TDP and VF were observed in the hospital. The patient was found to have ingested hallucinogenic mushrooms, but association between psilocybin and rhythm disturbances was not confirmed. Single-chamber ICD was implanted. Conclusions Psilocybin may provoke ventricular arrhythmias in predisposing conditions, such as congenital or acquired abnormalities of the heart's conduction system (e.g., long QT interval) and electrolyte imbalances.