A case report of a 22-year-old healthy Austrian man who suffered an out-of-hospital cardiac arrest (asystole) after consuming kratom tea, with toxicological confirmation of markedly elevated mitragynine blood levels (500 µg/L; local reference 20–100 µg/L), and no other substances detected.
The patient achieved sustained ROSC after ~8 minutes of advanced life support; cardiac and genetic workup found no structural or hereditary cause, implicating isolated mitragynine toxicity. He required a permanent pacemaker for recurrent severe bradycardia (< 30 bpm) on day 6 and was discharged neurologically intact at 2 weeks.
Single case report limits generalizability; exact mechanism of cardiac arrest (seizure-triggered vs. direct cardiotoxicity) remains unresolved; no established toxic or lethal mitragynine threshold exists, making causality attribution difficult.
Clinicians should consider kratom (mitragynine) toxicity in young patients with unexplained cardiac arrest or severe bradycardia, especially when standard toxicology screens are negative—targeted mass spectrometry testing is required, as mitragynine is not detected by routine panels.
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