Energy drink-induced cardiomyopathy

Abstract

We report a case of severe biventricular heart failure potentially related to excessive energy drink consumption in a 21-year-old man. The patient presented with a 4-month history of shortness of breath on exertion, orthopnoea and weight loss. Transthoracic echocardiography demonstrated severely impaired biventricular systolic function and bilateral ventricular thrombi, subsequently confirmed on cardiac magnetic resonance imaging, which found in addition no oedema, inflammation or focal fibrosis. Blood tests, renal ultrasound and subsequent abdominal MRI demonstrated severe renal failure caused by a chronic obstructive uropathy, long-standing and previously undiagnosed. There was no significant past medical, family or social history other than excessive intake of an energy drink. This case report adds to the growing concern in the literature about the potential cardiotoxic effects of energy drinks, which should be considered when assessing young patients presenting with a non-ischaemic dilated cardiomyopathy.

Keywords: cardiovascular medicine; heart failure.

Figure 1

Admission ECG.

Figure 3

Creatinine trend during admission.

Figure 2

Troponin T trend during admission.

Figure 4

Cardiac magnetic resonance 11/12/19 (A) Mid-short axis T1 map: normal homogenous values throughout the myocardium imaged. (B) Late gadolinium four-chamber view. (C) Late gadolinium two-chamber view. (D) Late gadolinium three-chamber view.

Figure 5

Admission chest X-ray showing an enlarged heart size, no focus of consolidation, collapse, sizeable pleural effusion or pulmonary congestion.