Severe Nonischemic Dilated Cardiomyopathy Associated With Multi-Ingredient Herbal Supplement Use

BACKGROUND: Herbal supplements marketed for cognitive and cardiovascular enhancement are widely used, yet safety data remain scarce. Supplement-associated cardiomyopathy is a rare but life-threatening complication that remains underrecognized. CASE SUMMARY: A 39-year-old previously healthy man developed progressive dyspnea, and bilateral leg edema 2 months after initiating a multi-ingredient herbal supplement. Echocardiography revealed severe left ventricular dysfunction (ejection fraction 10%-15%). Comprehensive evaluation excluded ischemic, infectious, autoimmune, infiltrative, and toxicologic causes. Despite maximal guideline-directed therapy, the patient required orthotopic heart transplantation. Genetic testing was not obtained, representing a workup limitation. DISCUSSION: Multiple supplement ingredients lacked published cardiovascular safety data. The temporal association between supplement initiation and rapid progression to biventricular failure, in the absence of any identifiable alternative etiology, raises concern for supplement-associated cardiotoxicity. Clinicians should obtain thorough supplement histories in unexplained heart failure. TAKE-HOME MESSAGES: This case underscores the cardiotoxic risk of multi-ingredient herbal supplements and the need for heightened clinical vigilance.