International Journal of Cardiology 179 (2015) 66–67

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International Journal of Cardiology journal homepage: www.elsevier.com/locate/ijcard

Letter to the Editor

Left main coronary artery thrombosis and acute anterior myocardial infarction related to energy drink Sefa Ünal a,⁎, Barış Şensoy a, Samet Yilmaz a, Gülsüm Gamze Ünal b, Muhammed Süleymanoğlu a, Fatih Şen a, Burak Açar a, Mustafa Mücahit Balcı a a b

Turkiye Yuksek Ihtisas Education and Research Hospital, Turkey Hacettepe Universisty, Faculty of Medicine, Internal Medicine Department, Turkey

a r t i c l e

i n f o

Article history: Received 12 October 2014 Accepted 20 October 2014 Available online 22 October 2014 Keywords: Energy drink Acute myocardial infarction Left main coronary artery trombosis

A 32 year-old previously healthy man presented the emergency department with a 6-hour history of retrosternal chest pain, palpitations and emesis. His symptoms started 5 or 6 h after drinking 5 bottles of energy drink. He denied cigarettes, alcohol, cocaine or other drug uses. There was no family history of premature coronary artery disease. At admission his vital signs were blood pressure 178/92 mm Hg, pulse 85, temperature 37 °C, 98% oxygen saturation, and breathing was rate 22 respirations per minute. Physical examination was unremarkable. The ECG showed marked ST elevation V2 through V6 (Fig. 1). A bedside echocardiogram demonstrated anterior, apical and interventricular septum hypokineses, and normal aorta and left ventricular EF was 35%. An emergent coronary angiogram performed demonstrated a large thrombus occupying nearly 90% of the diameter of the left main coronary artery and a second thrombus that occluded the proximal left anterior descending artery (Fig. 2a,b,c). No atherosclerotic lesions or coronary malformations were identified. After coronary angiogram we performed balloon angioplasty to a 100% thrombotic LAD lesion. Before angioplasty intracoronary tirofiban bolus was administrated. After balloon angioplasty LAD flow was achieved at proximal segment but TIMI 0 flow at distal segment. Although repeated balloon angioplasty distal LAD flow could not be achieved. After angioplasty procedure the patient was admitted to coronary care unit. After 24-hour tirofiban and heparin infusion control angiography was planned but the patient refused control angiography.

⁎ Corresponding author. E-mail address: [email protected] (S. Ünal).

http://dx.doi.org/10.1016/j.ijcard.2014.10.073 0167-5273/© 2014 Elsevier Ireland Ltd. All rights reserved.

Further laboratory tests, including a lipid profile and coagulation panel, were within normal limits. Anticardiolipin antibodies, homocysteine level, and protein C and protein S activities were negative or within normal ranges. The patient was discharged home with dual antiplatelet therapy. Energy drink consumption is increasing and has become very popular, especially among young people. Previous case reports had linked energy drinks with sudden cardiac death, coronary vasospasm, reversible postural tachycardia syndrome, and serious arrhythmias, including ventricular fibrillation. Most of the cases were related to overuse or concomitant alcohol intake [1–4]. Almost all such commercially available drinks have the same basic stimulants, caffeine, glucoronolactone, taurine, and vitamins, and it is difficult to know which component is responsible for the effect in platelet aggregation and endothelial function. Energy drink consumption acutely increases platelet aggregation and decreases endothelial function in healthy young adults [4]. Endothelial function acutely becomes worse after drinking energy beverage [5]. These drinks contain, among other ingredients, large amounts of caffeine. Though these drinks contain many other ingredients in addition to caffeine, there is little evidence they bare any hazards. Caffeine in high doses is well related to various adverse effects, and though it has a wide therapeutic index, there are many reports of serious toxicities, even death [6]. The effects of energy drinks should be better investigated because of their increasing consumption by the public and their potentially lethal effects.

References [1] Alexandre M. Benjo, Andrés M. Pineda, Francisco O. Nascimento, Carlos Zamora, Gervasio A. Lamas, Esteban Escolar, Left main coronary artery acute thrombosis related to energy drink intake, Circulation 125 (2012) 1447–1448. [2] A.J. Berger, K. Alford, Cardiac arrest in a young man following excess consumption of caffeinated energy drinks, Med. J. Aust. 190 (2009) 41–43. [3] R. Terlizzi, C. Rocchi, M. Serra, L. Solieri, P. Cortelli, Reversible postural tachycardia syndrome due to inadvertent overuse of Red Bull, Clin. Auton. Res. 18 (2008) 221–223. [4] J.P. Higgins, T.D. Tuttle, C.L. Higgins, Energy beverages: content and safety, Mayo Clin. Proc. 85 (2010) 1033–1041. [5] M.I. Worthley, A. Prabhu, P. De Sciscio, C. Schultz, P. Sanders, S.R. Willoughby, Detrimental effects of energy drink consumption on platelet and endothelial function, Am. J. Med. 123 (2010) 184–187. [6] J.P. Higgins, Endothelial function acutely worse after drinking energy beverage, Int. J. Cardiol. 168 (2) (Sep 30 2013) e47–e49.

S. Ünal et al. / International Journal of Cardiology 179 (2015) 66–67

Fig. 1. The 12 derivation ECG showed marked ST elevation V2 through V6.

Fig. 2. a: Thrombus in LMCA and 100% occluded LAD. b: Total occlusion at distal LAD after balloon angioplasty. c: Thrombus in LMCA after angioplasty procedure.

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Left main coronary artery thrombosis and acute anterior myocardial infarction related to energy drink.

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