Weight loss is one of the most researched and marketed topics in American society. Dietary regimens, medications that claim to boost the metabolism, and the constant pressure to fit into society all play a role in our patient’s choices regarding new dietary products. One of the products that are well known to suppress appetite and cause weight loss is amphetamines. While these medications suppress appetite, most people are not aware of the detrimental side effects of amphetamines, including hypertension, tachycardia, arrhythmias, and in certain instances acute myocardial infarction. Here we present the uncommon entity of an acute myocardial infarction due to chronic use of an amphetamine containing dietary supplement in conjunction with an exercise regimen. Our case brings to light further awareness regarding use of amphetamines. Clinicians should have a high index of suspicion of use of these substances when young patients with no risk factors for coronary artery disease present with acute arrhythmias, heart failure, and myocardial infarctions.
Amphetamines are widely known to cause appetite suppression and encourage weight loss. Their other known side effects are hypertension, tachycardia, arrhythmias, and myocardial infarctions [
A 35-year-old African American female with no prior history of coronary artery disease and no significant family history presented with sudden onset of exertional chest discomfort with radiation to the back. The patient became unresponsive shortly after arrival to the emergency department and was subsequently found to be in ventricular fibrillation-cardiac arrest (V-fib). The patient was in V-fib for 6 minutes, with conversion after electrical cardioversion and subsequent development of PEA-arrest for a total of 4 minutes. Repeat EKG after return of spontaneous circulation demonstrated inferolateral STEMI (Figure
Presenting EKG showing inferior-lateral ST segment elevation.
Left heart catheterization representing 99% occlusion of mid-distal LAD.
Left heart catheterization representing 99% occlusion of mid-distal LAD.
Left heart catheterization image postimplantation of two overlapping drug eluting stents, depicting TIMI 3 flow.
The patient’s cardiac function recovered with medical management. Subsequent transthoracic echocardiograms revealed improved ejection fraction to 60–65% after 11 days and a new finding of left ventricular apical thrombus. The patient received anticoagulation with intravenous heparin, as well as continuous treatment with dual antiplatelet therapy with aspirin and clopidogrel.
The patient remained in the coronary care unit (CCU) for a total of 17 days. CCU course was further complicated by development of pulmonary edema with diffuse alveolar hemorrhage and developing MRSA and pseudomonas pneumonia.
Due to the need for prolonged mechanical ventilation, the patient received a tracheostomy and continued to improve in terms of her pulmonary function while treated with antibiotics for ventilator-associated pneumonia. Her neurological status improved significantly, and on interview, she denied any use of Adderall, amphetamines, or illicit drugs that could have precipitated this event. She reported that recently she had increased her level of physical activity in order to lose weight and was supplementing such efforts with the addition of a natural weight loss dietary supplement.
Amphetamine use is strongly associated with coronary artery disease [
There are multiple cases reported in the literature involving the development of an acute myocardial infarction due to amphetamine abuse. Chang and colleagues reported an unusual case of a silent ST elevation myocardial infarction following amphetamine use in a 61-year-old diabetic patient. In their case, the patient presented to the hospital without chest pain and normal cardiac enzymes; however, EKG revealed ST elevations in the inferior leads with reciprocal changes in the precordial leads. Subsequent percutaneous coronary angiography revealed total occlusion of the posterior-lateral segment of the right coronary artery. On further history, the patient had reported abusing amphetamines via inhalation prior to presentation [
One of the side effects of amphetamine use is decreased appetite, a side effect that is desirable to some patients. The realization of such effect and the potential for inducing weight loss led to the introduction of amphetamines as appetite suppressants in the 1950s and development of the combination of Phentermine and Fenfluramine in the 1990s [
In view of the positive toxicology screen for amphetamines and the lack of history of abuse or use by our patient, we propose the notion that weight loss dietary supplements in fact may contain amphetamines or amphetamine-like substances. With the popularity of such products among patients searching for aids in weight loss, there is a possibility that a portion of the population who regularly use these products might be exposed to unregulated levels of amphetamines or amphetamine-like substances. The acute and chronic consequences of use of these substances can be detrimental to patients, as they are at a higher risk for acute myocardial infarctions, increased risk of accelerated atherosclerosis, and early development of cardiac dysfunction due to recurrent myocardial injury [
Our case illustrates how inadvertent use of amphetamines by patients with no history, risk factors, or significant family history of coronary artery disease can be the culprit for life threatening events. Patients often struggle with weight management, looking for alternatives to supplement their efforts to lose weight. Without proper disclosure and recent trend of the addition of amphetamines to dietary supplements [
The authors declare that they have no competing interests.