Ephedra
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Coronary artery aneurysm and thrombosis: case report A 29-year-old man experienced coronary artery aneurysm and thrombosis after administration of ephedra and herbal supplements containing ephedra [dosages and therapeutic indication not stated]. The man presented with dyspnoea, diaphoresis, and a 3-day history of left-sided chest tightness on exertion. Symptoms occurred up to 5 times daily. He admitted to extensive use of herbal supplements, including Ma Huang for several months in 1996, Xenadrine® RFX in 2001 for 1 year, and Hydroxycut® in 2003. He used the drugs at recommended doses but had stopped due to their ineffectiveness [time to reaction onset not stated]. On examination, he was overweight with a BMI of 36.8, and had a BP of 118/60 mmHg. Bradycardia was observed, with a HR of 47 bpm. Laboratory tests showed mildly elevated concentrations of serum creatinine kinase, creatine kinaseMB and troponin I, with a total cholesterol level of 278 mg/dL. The man was diagnosed with a non-ST elevation myocardial infarction and received aspirin, low molecular weight heparin, and a β adrenergic receptor antagonist. A left heart catherisation showed diffuse luminal irregularities in the left coronary system and multiple coronary aneurysms. An aneurysm in the mid-RCA was completely occluded by a large thrombus and attempts at thrombectomy and cannulation of the distal vessel were unsuccessful. He was placed on a eptifibatide drip, and after 72 hours, percutaneous intervention was achieved and there was TIMI 3 flow. An intravascular ultrasound concluded that atherosclerotic burden was minimal. An MRI showed no further aneurysm. Author comment: "Ephedra and pseudoephedrine have been associated with vasospastic myocardial infarction . . . We propose that chronic ephedrine use may lead to the development of aneurysms similar to cocaine, perhaps due to recurrent vasospasm." Flanagan CM, et al. Coronary artery aneurysm and thrombosis following chronic ephedra use. International Journal of Cardiology 139: e11-e13, No. 1, 18 Feb 2010. Available from: URL: http://dx.doi.org/10.1016/j.ijcard.2008.06.081 803014284 USA
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Reactions 19 Jun 2010 No. 1306
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