Ephedrine‐Induced Cardiac Ischemia: Exposure Confirmed with a Serum Level

Abstract

The temporal association of symptoms consistent with ephedrine toxicity after ingestion of ephedrine‐containing dietary supplements is heavily relied upon to confirm exposure. Few reports in the literature attempt to associate toxicity with serum levels of these drugs. We report a case of ephedrine‐induced cardiac ischemia confirmed by a plasma level. A 22‐year‐old woman ingesting an ephedrine‐ and caffeine‐containing product for 2 days presented with multiple symptoms, including palpitations, nausea, tremulousness, abdominal pain, and vomiting. The initial electrocardiogram (ECG) revealed a normal sinus rhythm with 1 mm of ST segment depression in leads V3 and V4, along with inverted T waves in leads V1–V4. Her symptoms and ST segment depression resolved over several hours with medical management. The amplitude of her T wave inversions notably diminished with therapy; however, they did not completely resolve. Troponins at presentation and the following morning were negative, and an echocardiogram showed only trace tricuspid regurgitation. A serum ephedrine level, drawn approximately 6 to 7 hr after ingestion, was 150 ng/mL. She was discharged from the hospital after being instructed to avoid ephedrine‐containing products.

Keywords :

• Ephedrine
• Cardiac
• Ischemia