Out of whack on ‘Sopranos’: valerian tea and ER protocol

“The Sopranos,” season finale, HBO, June 4.

The premise

CHRISTOPHER Moltisanti’s (Michael Imperioli) new girlfriend is Julianna (Julianna Margulies), formerly involved with Tony Soprano. Christopher and Julianna meet at an Alcoholics Anonymous meeting, which they attend because of drug addiction.

During one of their trysts, Julianna is suffering from a bad cold, and Christopher suggests Robitussin with dextromethorphan. Julianna declines, seeming to know that dextromethorphan is a semi-synthetic narcotic that, if taken in high doses, could make her high and perhaps again provoke her drug addiction.

Instead, she suggests eight to 10 tea bags for a container of valerian tea, which she says is in the same chemical family as Valium. She hopes it will help her sleep and treat her cough. When we next see Julianna, her cough is clearly improved, but she is again snorting drugs with Christopher, who carries a container of what appears to be valerian tea.

Meanwhile, Patty Leotardo takes her husband, Phil (Tony Soprano’s enemy), to the hospital with a tightness in his chest “up by my esophagus.” The emergency room doctor reports that his cardiac enzymes are normal and sends Phil home, but he soon returns with a massive heart attack.

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The medical questions

WHAT is valerian tea? Is it in the same family as Valium? Does it treat a cough? Is it addictive and would it cause a patient to return to using narcotics? Does it help a person sleep?

Is it believable that the doctor would tell Phil that his heart is fine? Could his chest pains be coming from his esophagus rather than his heart? Could this type of heart attack be avoided through proper emergency care?

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The reality

VALERIAN is an herb with sedative properties used to ease insomnia and anxiety. It isn’t chemically related to Valium, and it won’t relieve a cough. Long-term use of the herb has been shown to have addictive properties, but there is no evidence that its use -- whether in tea or capsule form -- would cause someone to return to drug addiction.

Regarding Phil’s heart attack, a doctor is unlikely to send him home with classic angina symptoms -- whether his cardiac enzymes initially showed damage or not.

It is standard hospital protocol to admit a patient with these warning symptoms overnight for further monitoring and cardiac tests (beginning with serial cardiac enzymes). Timely intervention with a cardiac catheterization and coronary stent may prevent a big heart attack from occurring.

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Dr. Marc Siegel is an internist and an associate professor of medicine at New York University’s School of Medicine. In the Unreal World, he explains the medical facts behind the media fiction.