1153

Abstract

Case report: A 21 year old healthy male had a witnessed out-of-hospital cardiac arrest while exercising. He received bystander cardio-pulmonary resuscitation and defibrillation, continued in the emergency department with return of spontaneous circulation (ROSC). ECG showed diffuse ST segment elevation without QT prolongation. Emergent cardiac catheterization revealed normal coronary arteries. Because he remained comatose after ROSC, he underwent therapeutic hypothermia. He had no family history of sudden cardiac death and no recent chest trauma; however, he had just started taking a dietary supplement containing 1,3-dimethylamylamine (DMAA). Urine drug screen was positive for amphetamines by immunoassay but negative by gas chromatography/mass spectrometry (GC-MS). Echocardiogram revealed an ejection fraction of 35% without evidence of structural heart disease or right ventricular strain, with normalization of systolic function several days later. Electroencephalogram was negative for seizure activity. Cardiac MRI was also unremarkable. Patient was extubated by day 3. He confirmed ingesting the supplement for the first time prior to exercising on the day of admission. Patient underwent ICD implantation. Cerebral performance category (CPC) at 8 weeks was 1. Discussion: DMAA is structurally similar to amphetamines, and individuals may screen falsely positive on initial amphetamine immunoassay test, with a negative result on GC-MS. DMAA is used in over 200 sports supplements due to its stimulant effects. DMAA containing supplements have been implicated in panic attacks, seizures, cardiomyopathy, and deaths, leading to removal of all DMAA-containing products from the military. Recently the FDA issued warnings to manufacturers of supplements containing DMAA requiring evidence to demonstrate product safety. Our case has been reported to the FDA. This case underscores the need for clinicians to be aware of the potential harm of the DMAA-containing products by maintaining a high index of suspicion in otherwise healthy individuals presenting with cardiac arrest.