Ventricular tachycardia induced by abuse of ephedrine in a young healthy woman.
BACKGROUND
Ephedrine or ephedra herbal products have occasionally been used to enhance sports performance and energy or to aid weight loss. The most serious side effects are those on cardiovascular function, including acute myocardial infarction, severe hypertension, myocarditis and lethal cardiac arrhythmias.


METHODS
A 19-year-old woman was taking ephedrine to enhance her sports performance. After 10 days of this medication she developed hemodynamically unstable ventricular tachycardia resistant to cardioversion and amiodarone treatment. She converted to sinus rhythm 60 hours later, presumably when the plasma ephedrine level had sufficiently decreased. In an electrophysiological study the ventricular tachycardia could be induced and successfully ablated. There were no recurrences during follow-up of more than a year. The use of ephedrine carries a risk of development of life-threatening arrhythmias.


CONCLUSIONS
Ephedrine alone cannot be considered as the ultimate cause of tachycardia in our patient; however, it is highly probable that ephedrine triggered the tachycardic attack. The proarrhythmic effect most likely occurred because of underlying idiopathic left ventricular tachycardia. Although the patient could have developed her first attack of ventricular tachycardia at any time in her life, it is highly improbable that the attack following the ephedrine abuse was purely coincidental.


CONCLUSIONS
Our experience with the reported patient shows that ephedrine alone, or in combination with substances that increase its effects on the cardiovascular system, may also trigger paroxysms of non-ischemic ventricular tachycardia. The use of ephedrine carries a risk of development of life-threatening arrhythmias and should be discouraged.
Rakovec
Peter
P
Department of Cardiology, University Medical Center, Ljubljana, Slovenia. peter.rakovec@kclj.si
Kozak
Matija
M
Sebestjen
Miran
M
D000328:Adult; D000638:Amiodarone / Q000008:administration & dosage / Q000627:therapeutic use; D000889:Anti-Arrhythmia Agents / Q000008:administration & dosage / Q000627:therapeutic use; D004562:Electrocardiography; D004594:Electrophysiology; D004809:Ephedrine / Q000008:administration & dosage / Q000009:adverse effects* / Q000097:blood; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D012307:Risk Factors; D019966:Substance-Related Disorders; D017180:Tachycardia, Ventricular / Q000139:chemically induced* / Q000175:diagnosis / Q000188:drug therapy / Q000503:physiopathology; D013997:Time Factors
D000889:Anti-Arrhythmia Agents; D004809:Ephedrine; D000638:Amiodarone