Ephedra–Associated Cardiomyopathy

Abstract

OBJECTIVE To report 2 cases of cardiomyopathy associated with use of dietary supplements containing ephedra. CASE SUMMARIES A 19-year-old white man presented to the emergency department (ED) complaining of exertional shortness of breath and episodic chest pain radiating to the left arm. Left heart catheterization revealed no significant coronary artery disease, a dilated left ventricle, and global hypokinesis. He was discharged home 5 days after admission on standard therapies for heart failure, but died 5 weeks later. A 21-year-old white man presented to the ED with recurrent chest pain and was diagnosed with myopericarditis. An echocardiogram showed global hypokinesis with an ejection fraction of 40–50%. He was treated for myopericarditis with standard therapies for heart failure. An objective causality assessment probability scale revealed that an adverse drug reaction was possible between cardiomyopathy and ephedra use in these 2 patients. Both of these cases have been reported to MedWatch. DISCUSSION Ephedrine is a potent sympathomimetic agent with direct and indirect effects on adrenergic receptors to cause increases in heart rate, blood pressure, cardiac output, and vascular resistance. The adverse effects of adrenergic stimulation are well known in cardiomyopathy, inducing direct and indirect myocyte toxicity. CONCLUSION It is well documented that ephedra, through its sympathomimetic effects, can cause a range of cardiovascular toxicities including myocarditis, arrhythmias, myocardial infarction, cardiac arrest, and sudden death.