Children Like Chocolates; Does Chocolates Like Children or Their Hearts?

Abstract

To the Editor : Chocolate, especially the dark one could have beneficial effects on the heart due to its vasodilatory action. But it may have an arrhythmic effect when consumed regularly in large amounts. We report the case of a 2.5-y-old boy with ventricular arrhythmia which is thought to be due to heavy chocolate intake. He was admitted to the hospital for the complaint of low appetite. All the physical examination findings (weight, height, heart rate, body temperature, systemic examination) were normal except for the presence of cardiac arrhythmia. Neither he nor his parents had any known chronic disease (arrhythmia, hyperthyroiditis, etc.). He was also not on any sort of medications. Electrocardiography (ECG) showed monomorphic ventricular extrasystoles (VES) which were coming regularly after four sinus rhythms (Fig. 1). The laboratory findings like hemoglobin, troponin, thyroid function tests and electrolytes were normal. The echocardiographic parameters were also normal. Since the patient’s complaint was low appetite, the feeding habbits were enquired and it was learned that he had been consuming nearly 2 bars (100–160 g) of milky chocolate per day regularly. Since there was no evidence for the possible reasons of arrhythmia like anemia, hyperthyroiditis, drug misuse/ adverse effect or myocarditis, it was assumed that these frequent ventricular extrasystoles could be due to patient’s heavy cacao intake. Thus, it was eliminated from the diet. Four days later, the physical examination and ECG findings were normal. After a month of chocolate forbidden diet, chocolate in same amount was added to the diet again to show its arrhythmogenic effect. On the 3rd day of consuming the chocolate, regular monomorphic ventricular early contractions coming after 5 to 6 normal sinus contractions were observed again. Although the effects of dietary factors on the heart and circulatory system are known for a very long time, but when the literature was searched, a few articles on cardiac effects of chocolate and cacao in the childhood period were found and that too to show the benefits of chocolate and cacao due to their vasodilatory effect. There are also a few articles written on the adverse effects of chocolate but most of these studies were done on the adult population. Now-a-days, vasodilatory effects of dark chocolates on peripheral and coronary vessels and their benefits for the adult heart have became an interesting subject in the literature [1–4]. Chocolate and cacao contain flavonoids which have different formulations. They contain some coronary artery dilatators like polyphenols and also myocardial stimulators like methylxanthines especially, teobromine [3, 4]. Thus, to conclude, chocolate can cause frequent extrasystoles in children. The case also suggests that if any child having arrhythmia is seen without any known reason, the feeding habits, especially the chocolate intake should be asked. * Sibel Bozabali sibelbozabali@gmail.com