Cardiomyopathy Associated With Ephedra‐Containing Nutritional Supplements

Abstract

with both S3 and S4 gallops. The lungs were clear, and extremities were without edema. The remainder of the results of the physical examination were normal. Laboratory findings included normal complete blood cell count, serum chemistry, and liver function test results. Serum ferritin and thyroid function test findings were normal. Immunologic testing for Toxoplasma species, Lyme disease, and Ehrlichia species were negative. Chest radiography showed cardiomegaly, and electrocardiography revealed sinus tachycardia. Two-dimensional echocardiography demonstrated left ventricular dysfunction with severe global hypokinesia and an estimated left ventricular ejection fraction (LVEF) of 10% to 15%. Right heart catheterization revealed a pulmonary capillary wedge pressure of 24 mm Hg and mild pulmonary hypertension. Left heart catheterization revealed an LVEF of 10% with severe global hypokinesia, a left ventricular end-diastolic pressure of 7 mm Hg, and a left dominant coronary system with normal coronary arteries. Right ventricular biopsy revealed minimal changes and probable idiopathic cardiomyopathy. The patient was advised to stop taking the ephedra-containing dietary supplement, and medical treatment was started with aspirin, a b-blocker, and an angiotensin-converting enzyme inhibitor, with subsequent symptom improvement. The patient could not tolerate spironolactone therapy because of hyperkalemia. Repeat echocardiography performed 3 years later showed marked improvement in left ventricular systolic function, with an estimated LVEF of 45% to 50%.