Hydroxycut Supplement Induced Reverse Takotsubo Cardiomyopathy
Document Type
Article
Abstract
Background: Hydroxycut, a herbal supplement for weight loss, is associated with multiple side effects. We report a case of reverse Takotsubo cardiomyopathy (rTCM) induced by Hydroxycut supplementation; the first reported case of Hydroxycut induced rTCM in literature.
Case: A 69-year-old female with chronic left bundle branch block (LBBB) presented with chest pressure and shortness of breath which started 1 hour after taking her first dose of Hydroxycut. Her pulse was 137 beats/minute, oxygen saturation was 89% on room air, and blood pressure was 84/58 mmHg. Electrocardiogram showed a LBBB. Troponin I was 1.73ng/mL. IV heparin was initiated, and she was loaded with aspirin and ticagrelor. An urgent left heart catheterization showed patent coronary arteries. Left ventriculogram was suggestive of reverse Takotsubo cardiomyopathy. An intra-aortic balloon pump was inserted for cardiogenic shock. Echocardiogram showed a left ventricular ejection fraction (LVEF) of 25% with severe diffuse hypokinesis of the mid ventricular walls, and hyperkinesis in the basal inferolateral apical segments. Following improvement, the balloon pump was removed. Guideline directed medical therapy was started on discharge. Echocardiogram 60 days later showed an improved LVEF of 60% and no regional wall motion abnormalities.
Decision-making: rTCM is almost always associated with a physical or mental stress. Catecholamine mediated myocardial stunning, coronary artery spasm, and coronary microvascular impairment are some of the proposed mechanisms. Caffeine and robusta coffee bean extract found in Hydroxycut are known to increase the sympathetic tone of the myocardium and raise the intracellular calcium in myocytes with an antagonist effect on myocardial adenosine receptors A1 and A2A. The absence of other triggers and association of caffeine with possible catecholaminergic surge and myocardial blood flow makes this supplement the likely etiology of rTCM in our patient.
Conclusion: rTCM is a rare occurrence. Given the wide use of these supplements, identifying an association with Hydroxycut and rTCM is important for the diagnosis and avoidance of repeated exposure to triggers when managing these patients.
First Page
3580
DOI
10.1016/S0735-1097(23)04024-X
Publication Date
3-7-2023
Recommended Citation
Amaratunga EA, Thacker P, Shirani J. HYDROXYCUT SUPPLEMENT INDUCED REVERSE TAKOTSUBO CARDIOMYOPATHY. Journal of the American College of Cardiology. 2023 Mar 7;81(8_Supplement):3580-.