MA HUANG-INDUCED MYOCARDIAL INFARCTION WITH NORMAL CORONARY ARTERIES

Background: Ma Huang (Ephedra sinica) is a natural form of ephedrine commonly sold as a nutritional supplement. Ephedrine is rarely reported to cause chest pain syndrome. However, we were unable to find any other cases of Ma Huang-induced myocardial infarction with angiographic evaluation. Case Report: A 30-year-old male body builder took four pills of a weight loss product containing Ma Huang (334 mg each) as instructed by the product label. The patient also reported taking testosterone, but his last cycle was one month prior. He presented to the emergency department complaining of right-sided chest pain. Initial vital signs were: HR 112 bpm; BP, 132/82; RR 16 rpm; 97.8 [degrees] F and physical examination only revealed mild right chest wall tenderness. Initial therapy with ketorolac was ineffective. Subsequently, and ECG revealed T wave inversions in leads III and AVF with poor R waver progression. Aspirin, sublingual nitroglycerin and morphine were given to control pain and a repeat ECG now showed normal R wave progression. Urine toxicology screen was negative for cocaine and amphetamines. The patient's first cardiac enzymes were as follows: CPK 447 IU/L; Troponin I 14.4 ng/mL; MB 6.2%. An emergent cardiac catheterization demonstrated normal coronary arteries, mild global LV hypokinesis and mild LVH. He was admitted to the CCU with subsequent normalization of cardiac enzymes and was discharged on day 3 with warnings regarding stimulant use. Conclusion: Ma Huang (ephedrine) is a vasoactive stimulant capable of causing cardiac injury in 'recommended doses' even in the absence of underlying heart disease. As such, stricter regulation of these agents should be considered.
Sharma AN, Cinci PM, Hoffman RS. New York City Poison Control Center, New York, [...]