Abstract
Ephedrine is a sympathomimetic substance used by sportsmen as a doping substance because of its stimulating and slimming effects. We report two cases of ventricular arrhythmias induced by abuse of ephedrine in two competitive athletes. Endomyocardial biopsies guided by electroanatomic mapping revealed contraction-band necrosis, a myocardial injury frequently observed in cases of catecholamine excess. Our cases suggest that long-term abuse of ephedrine may result in myocardial damage, and that these structural alterations may promote areas of slow conduction favoring re-entrant ventricular tachyarrhythmias and a long-lasting risk of ventricular arrhythmias.
This is a preview of subscription content, log in via an institution to check access.
References
Abraham J, Mudd JO, Kapur NK, Klein K, Champion HC, Wittstein IS (2009) Stress cardiomyopathy after intravenous administration of catecholamines and beta-receptor agonists. J Am Coll Cardiol 53:1320–1325
Dello Russo A, Pieroni M, Santangeli P, Bartoletti S, Casella M, Pelargonio G, Smaldone C, Bianco M, Di Biase L, Bellocci F, Zeppilli P, Fiorentini C, Natale A, Tondo C (2011) Concealed cardiomyopathies in competitive athletes with ventricular arrhythmias and an apparently normal heart: role of cardiac electroanatomical mapping and biopsy. Heart Rhythm 8:1915–1922
Kozakova M, Balkau B, Morizzo C, Bini G, Flyvbjerg A, Palombo C (2013) Physical activity, adiponectin, and cardiovascular structure and function. Heart Vessels 28:91–100
Patil HR, O’Keefe JH, Lavie CJ, Magalski A, Vogel RA, McCullough PA (2012) Cardiovascular damage resulting from chronic excessive endurance exercise. Mo Med 109:312–321
La Gerche A, Connelly KA, Mooney DJ, MacIsaac AI, Prior DL (2008) Biochemical and functional abnormalities of left and right ventricular function after ultra-endurance exercise. Heart 94(7):860–866
Franzen E, Mangold S, Erz G, Claussen CD, Niess AM, Kramer U, Burgstahler C (2013) Comparison of morphological and functional adaptations of the heart in highly trained triathletes and long-distance runners using cardiac magnetic resonance imaging. Heart Vessels 28:626–631
Li P, Zhao XX, Zheng X, Qin YW (2012) Arrhythmias after transcatheter closure of perimembranous ventricular septal defects with a modified double-disk occluder: early and long-term results. Heart Vessels 27:405–410
Maughan RJ (2005) Contamination of dietary supplements and positive drug tests in sport. J Sport Sci 23:883–889
To LB, Sangster JF, Rampling D, Cammens I (1980) Ephedrine-induced cardiomyopathy. Med J Aust 2:35–36
Conflict of interest
Michela Casella: None; Antonio Dello Russo: None; Gennaro Izzo: None; Maurizio Pieroni: None; Daniele Andreini: None; Eleonora Russo: None; Daniele Colombo: None; Fabrizio Bologna: None; Leonardo Bolognese: None; Paolo Zeppilli: None. Claudio Tondo serves as member of Advisory Board of Biosense Webster; he is also a consultant and receives lecture fees from St Jude Medical.
Author information
Authors and Affiliations
Corresponding author
Electronic supplementary material
Below is the link to the electronic supplementary material.
Movie 1. Noncontact mapping recording showing the VT origin at the basis of RVOT posterolateral wall. (MPG 4397 kb)
Movie 2. Noncontact mapping recording showing the origin of premature ventricular beats at the base of the RVOT posterolateral wall. The subsequent ventricular activation moves along a channel toward the RVOT anterior wall. (MPG 3412 kb)
Rights and permissions
About this article
Cite this article
Casella, M., Dello Russo, A., Izzo, G. et al. Ventricular arrhythmias induced by long-term use of ephedrine in two competitive athletes. Heart Vessels 30, 280–283 (2015). https://doi.org/10.1007/s00380-013-0455-6
Received:
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1007/s00380-013-0455-6