Bitter orange supplement use was associated with supraventricular tachycardia and myocardial injury (troponin I rise to 1,395.7 ng/L) in a 38-year-old woman without obstructive coronary disease.
Case Report (n=1)
Bitter orange supplements containing p-synephrine may be associated with supraventricular tachycardia and myocardial injury due to sympathetic stimulation.
BACKGROUND: Bitter orange (Citrus aurantium) is a common ingredient in weight-loss supplements and contains p-synephrine, a proto-alkaloid with sympathomimetic properties. Various cardiovascular adverse events have been reported after its use. CASE SUMMARY: A 38-year-old woman without cardiovascular risk factors presented with palpitations, atypical chest pain, and vomiting after 1 week of weight-loss-supplement use. Electrocardiography showed a supraventricular tachycardia, successfully terminated with 6 mg of intravenous adenosine. High-sensitivity troponin I rose from 17.9 to 1,395.7 ng/L. Transthoracic echocardiography was unremarkable, computed tomography pulmonary angiography excluded pulmonary embolism, and coronary angiography showed no obstructive coronary artery disease. Cardiac magnetic resonance demonstrated nonspecific late gadolinium enhancement. DISCUSSION: This case highlights a possible association between bitter orange supplement use and supraventricular tachycardia with myocardial injury in the absence of obstructive coronary disease. The likely mechanism involves p-synephrine-mediated sympathetic stimulation, with possible demand ischemia and/or vasospasm.
Plaitis et al. (Fri,) conducted a case report in Supraventricular tachycardia and myocardial injury (n=1). Bitter orange (Citrus aurantium) weight-loss supplement was evaluated on Supraventricular tachycardia and myocardial injury. Bitter orange supplement use was associated with supraventricular tachycardia and myocardial injury (troponin I rise to 1,395.7 ng/L) in a 38-year-old woman without obstructive coronary disease.