Sudden Unexplained Cardiac Arrest in Apparently Healthy Soldier: is Pre-Workout Supplement Safe!

Dietary pre workout supplements are commonly used in the US active duty population often without physician knowledge or appropriate screening. Selected dietary supplements have been associated with a number of unexplained cardiac arrest and death in service members. Many of these supplements are marketed as weight loss and athletic performance enhancement products. The association of various Ephedra-containing products with adverse cardiovascular events has led to a ban on the sale of these products by the U.S. Food and Drug Administration (FDA) in which it resulted in the emergence of a newer formulations marketed as "Ephedra-free" but contain other sympathomimetic substances, however, the safety of which has not been established. We report a case of active duty soldier who was taking commercially available dietary supplements called Cellucor C4; collapsed during routine morning exercise at his Navy base from cardiac arrest and ultimately survived. Our case highlights concerns that C4 in combination with other ingredients may be associated with significant consequences, reminiscent of previous adverse events from other sympathomimetic drugs previously removed from the market. Health care professionals, should be aware of the potential risk of these supplements and be prepared to discuss these risks with their patients.