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case report

Wien Klin Wochenschr (2012) 124:285287


DOI 10.1007/s00508-012-0163-8 Wiener klinische Wochenschrift
The Central European Journal of Medicine

A case of acute myocardial infarction due to the use


of cayenne pepper pills
Muhammet RasitSayin, TurgutKarabag, Sait
MesutDogan, IbrahimAkpinar, MustafaAydin

Received: 19 December 2011 / Accepted: 28 January 2012 / Published online: 20 April 2012
Springer-Verlag Wien 2012

Akuter Myokardinfarkt als Folge der Einnahme activation of the sympathetic nervous system, which in
von Cayenne Pfeffer Pillen: Ein Fallbericht turn increases energy expenditure and lipid metabolism
resulting in decreased fat tissue [1, 2]. Activation of the
Zusammenfassung Der Gebrauch von Cayenne Pfeffer sympathetic nervous system may exert deleterious meta-
enthaltende Pillen zur Gewichtsabnahme nimmt immer bolic and cardiovascular effects [3]. In this paper, we
mehr zu. Der Hauptwirkstoff der Cayenne Pfeffer Pillen present a case of a 41-year-old male patient with no car-
ist Capsaicin, dessen Wirkung auf das kardiovaskulre diovascular risk factors who took cayenne pepper pills to
System umstritten ist. In der vorliegenden Arbeit stel- lose weight and developed acute myocardial infarction.
len wir den Fall eines 41-jhrigen mnnlichen Patien-
ten ohne kardiovaskulre Risikofaktoren vor, der zur
Gewichtsabnahme Cayenne Pfeffer Pillen einnahm und Case report
einen akuten Herzinfarkt erlitt.
A 41-year-old male patient with no previous complaints
Schlsselwrter: Capsaicin, Akuter Herzinfarkt or disease presented to our emergency department with
squeezing chest pain started 8h ago. He had no known
Summary The use of weight loss pills containing cay- cardiovascular risk factors. He also had no family history
enne pepper has ever been increasing. The main com- of coronary artery disease. He reported no exposure to
ponent of cayenne pepper pills is capsaicin. There are emotional or physical stress. He had a 3month history of
conflicting data about the effects of capsaicin on the car- use of cayenne pepper pills to lose weight. On physical
diovascular system. In this paper, we present the case of examination, his blood pressure was 130/80mmHg and
a 41 year old male patient with no cardiovascular risk heart rate was 108 beats/min. Cardiovascular and respi-
factors who took cayenne pepper pills to lose weight and ratory system examination was normal. Analysis of the
developed acute myocardial infarction. ECGs revealed pathologic Q waves in leads V15; 4mm
ST segment elevation on V2, 3 mm in V3, 2 mm in V4;
Keywords: Capsaicin, Acute coronary syndrome 1mm ST segment elevation in aVL; 1mm reciprocal ST
segment depression in DII, III, and aVF (Fig. 1). Based
on theese findings, the patient was taken to the coronary
Introduction angiography laboratory for primary percutaneous coro-
nary intervention with the diagnosis of acute anterior
The use of weight loss pills containing cayenne pepper myocardial infarction. It was found that the left anterior
has ever been increasing. The main component of cay- descending artery (LAD) was 100 % occluded after the
enne pepper pills is capsaicin. Capsaicin increases cate- diagonal branch (Fig. 2). The left circumflex and right
cholamine secretion from the adrenal medulla through coronary artery were normal (Fig.2). A 3.525mm bare-
metal stent was implanted in the LAD after predilatation
with a 2.515mm balloon catheter. During the follow-up
M. R.Sayin,MD() T.Karabag, MD S. M.Dogan, MD
period, the peak troponin level was>50 ng/ml and the
I.Akpinar, MD M.Aydin, MD
Department of Cardiology, School of Medicine, Zonguldak peak CK-MB was>300ng/ml. The triglyceride level was
Karaelmas University, Kozlu 67600, Zonguldak, Turkey 38mg/dl, total cholesterol 144mg/dl, LDL 99mg/dl, and
e-mail: sayinmr@mynet.com HDL 37 mg/dl. Complete blood count, blood glucose,

13 A case of acute myocardial infarction due to the use of cayenne pepper pills 285
case report

nervous system is peculiar to the essential hypertensive


state, parallels the degree of the blood pressure eleva-
tion, is triggered by reflex and humoral mechanisms,
and may exert deleterious metabolic and cardiovascu-
lar effects, accelerating the progression of the end organ
damage accompanying hypertension [3]. Cases of hyper-
tensive crisis due to ingestion of capsaicin have been
previously reported [7, 8]. Cases of myocardial infarction
due to ingestion of capsaicin have also been previously
reported [8, 9]. One case presented with concomitant
Fig. 1 ECG
hypertensive crisis [8]; an another case was a 29-year-old
man who presented with acute myocardial infarction [9].
He had no angiographically visible atherosclerothic pla-
que and myocardial infarction was attributed to coronary
renal and liver function tests, thyroid function tests, and vasospasm because of topical capsaisin consumption. In
coagulation tests were all in the normal range. contrast to this patient, there was an atherosclerothic
The patient who was followed up for 1 week without plaque in our case and he had been exposed to capsaisin
any complications was prescribed nebivolol, ramipril, for a longer time. We believe that capsaisin consumption
hydrochlorothiazide, spironolactone, atorvastatine, clo- might trigger the acute coronary syndrome process con-
pidogrel, acetylsalicylic acid, and pantoprazole, and tributing to plaque erosion. Another experimental study
discharged from the hospital. The patient was followed has shown that capsaicin causes a decrease in coronary
up for one month without any problems. blood flow due to secondary endothelin release [10].
However, a recent study has shown that oral ingestion
of capsaicinoid has no effects different than placebo on
Discussion blood epinephrine and norepinephrine levels, and the
heart rate and blood pressure were not influenced [11].
The main component of cayenne pepper pills is capsai- The patients presented in the mentioned study had been
cin. Capsaicin is the active component of chili peppers, taking capsaicin for one week whereas the patient in our
which are plants belonging to the genus Capsicum. The case had been taking capsaicin for three months.
use of cayenne pepper pills containing capsaicin for the In the case presented, the use of chronic capsaicin
purpose of losing weight has ever been increasing. Expe- might have triggered acute coronary syndrome. Chronic
rimental studies have shown that intravenous adminis- consumption of these pills may affect plaque rupture with
tration of extracts of red pepper (capsiate, capsaicin, catecholamine discharge and hypertensive crisis resul-
etc) leads to catecholamine discharge resulting from the ting from the activation of sympathetic nervous system.
activation of sympathetic nervous system, as a result of There may be a vasospastic component due to secondary
which it was found that energy expenditure, blood pres- endothelin release. Unfortunately, any vasodilator drug
sure, and heart rate have increased in rats [4]. Human was not administered at the time of the cardiac cather-
studies also demonstrated that capsaicin induced the ization. It should also be kept in mind that this condition
adrenalin secretion through the activation of sympathe- may be a coincidence. However, in the case presented
tic nervous system and the heart rate and systolic blood young age, absence of cardiovascular risk factors and
pressure were significantly increased [5, 6]. Evidence has any other triggering factors suggest that capsaicin may
been also provided that the activation of the sympathetic lead to adverse cardiac outcomes. Thus, people should

Fig. 2 Left and Right coronary


angiography

286 A case of acute myocardial infarction due to the use of cayenne pepper pills 13
case report

be warned about use of this kind of product whose effects 6. Hachiya S, Kawabata F, Ohnuki K, Inoue N, Yoneda H,
have not been fully elucidated. Yazawa S, et al. Effects of CH-19 Sweet, a non-pungent cul-
tivar of red pepper, on sympathetic nervous activity, body
temperature, heart rate, and blood pressure in humans.
Conflict of interest Biosci Biotechnol Biochem. 2007;71:6716.
The authors report no conflict of interest. 7. Patan S, Marte F, La Rosa FC, La Rocca R. Capsaicin and
arterial hypertensive crisis. Int J Cardiol. 2010;144:e267.
8. Patan S, Marte F, Di Bella G, Cerrito M, Coglitore S. Cap-
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