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Background Ephedra is a sympathomimetic commonly used for the purposes of athletic performance enhancement and weight loss. It is known to be associated with gastrointestinal and psychiatric manifestations. We report here on 6 cases of dilated cardiomyopathy associated with ephedra use. Methods and results Over a period of 18 months, 6 patients attending our outpatient department with new onset heart failure were noted to have exposure to ephedra. The case record was reviewed and detailed clinical and echocardiographic data were extracted. All 6 patients (4 males) had left ventricular dysfunction at presentation (mean ejection fraction 20 ± 5%) and were treated with conventional heart failure pharmacotherapy. All patients discontinued ephedra use as advised. New York Heart Association class improved from class III in 5 patients (class II in 1 patient) to class I, within a median of 6 months (range 3–96). Ejection fraction improved to a mean of 47 ± 6%. Conclusions Ephedra may be associated with left ventricular systolic dysfunction. Withdrawal of this agent, in conjunction with proven pharmacotherapy, results in a significant improvement in functional status and left ventricular ejection fraction. We recommend specific enquiry into the use of over-the-counter supplements, particularly ephedra and its derivatives, when being evaluated with heart failure symptoms. These cases illustrate the potential risk of ephedra and provide additional support for the recent decision to ban this supplement.

A 56-year-old woman with a history of surgical removal of a invasive myocardial lipoma presented with progressive dyspnea. Transthoracic echocardiogram showed severe mitral and tricuspid regurgitation and severely impaired biventricular systolic function. Cardiac computed tomography was performed, showing extensive biventricular basal and mid-myocardial replacement by an infiltrating tumor that had the density of fat resulting in large aneurysms of the basal segments of both the ventricles. The patient is currently awaiting orthotopic heart transplantation.