title: STEMI in a 24-year-old man after use of a synephrine-containing dietary supplement: a case report and review of the literature.
abstract: Billions of dollars are spent annually in the United States in the largely unregulated market of dietary supplements. Many of these supplements are marketed as weight-loss and athletic-performance-enhancement products. The association of various ephedra-containing products with adverse cardiovascular events has led to a ban on the sale of these products by the U.S. Food and Drug Administration. The result has been the emergence of new formulations marketed for weight loss and athletic-performance enhancement that are "ephedra-free" but contain other sympathomimetic substances, the safety of which has not been established. We present the case of a previously healthy 24-year-old man who presented with an ST-segment-elevation myocardial infarction (STEMI) within hours of taking the ephedra-free product Nutrex Lipo-6x. Emergent coronary angiography revealed the presence of extensive, diffuse thrombus in the left anterior descending coronary artery. The patient had no risk factors for coronary artery disease or myocardial infarction; this includes the absence of a hypercoagulable state and the absence of a history of illicit drug use. This case of STEMI--associated as it is with the use of a synephrine-containing product by a person without risk factors for coronary artery disease--is to our knowledge the 1st reported in the literature. We discuss the patient's evaluation and clinical course, and we review the literature with respect to synephrine-containing dietary supplements. On the basis of synephrine's chemical composition and mechanism of action, we propose a direct association between this patient's use of Nutrex Lipo-6x and his STEMI.
authors.affiliation: Department of Medicine (Cardiology), Walter Reed Army Medical Center, Washington, DC 20307, USA. john.thomas4@amedd.army.mil
authors.forename: John E
authors.initials: JE
authors.lastname: Thomas
authors.forename: Jamalah A
authors.initials: JA
authors.lastname: Munir
authors.forename: Peter Z
authors.initials: PZ
authors.lastname: McIntyre
authors.forename: Michael A
authors.initials: MA
authors.lastname: Ferguson
mesh_terms: D000316:Adrenergic alpha-Agonists / Q000009:adverse effects*; D015906:Angioplasty, Balloon, Coronary; D002317:Cardiovascular Agents / Q000627:therapeutic use; D017023:Coronary Angiography; D003328:Coronary Thrombosis / Q000139:chemically induced* / Q000000981:diagnostic imaging / Q000628:therapy; D019587:Dietary Supplements / Q000009:adverse effects*; D004562:Electrocardiography; D006801:Humans; D008297:Male; D009203:Myocardial Infarction / Q000139:chemically induced* / Q000000981:diagnostic imaging / Q000628:therapy; D013578:Synephrine / Q000009:adverse effects*; D016896:Treatment Outcome; D055815:Young Adult
chemical_list: D000316:Adrenergic alpha-Agonists; D002317:Cardiovascular Agents; D013578:Synephrine