I recall getting a call from the emergency department (ED) several years ago about a young man in his early 30s presenting with typical angina at rest. A quick glance at his electrocardiogram (ECG) revealed an ST-elevation myocardial infarction (STEMI), and his troponins exceeded 35 ng/mL.
I took him straight to the catheterization lab, where he was found to have a sticky thrombus occluding the left anterior descending artery, but no other significant coronary artery disease. I remember going back and asking him questions to figure out why a 30-something-year-old was having a myocardial infarction.
He wasn’t a smoker, had no family history of coronary artery disease, and had no risk factors. The only thing that stood out at the time was that he was an avid drinker of energy drinks. He had gulped down a couple off-brand energy drinks filled with unrecognizable ingredients and lots of vitamin B6, vitamin B12, and caffeine.
The case was anecdotal, at best, and when I brought up the possibility of an acute thrombus induced by an energy drink, my attendings were not the least bit interested. A couple years later, I ran into a case where a group of college students were up late partying and had decided to challenge each other to see who could drink the most energy drinks.
Apparently, they all fell sick that night as a result, but 1 of them began to have severe substernal chest pressure typical of angina. In the ED, he was found to have significant ST elevations and was taken to the catheterization lab, where he was found to have significant clot burden occluding all his coronary arteries. He required urgent coronary artery bypass surgery.
Apparently, I wasn’t the only one noticing this surge in myocardial infarctions in young individuals and an association with caffeinated beverages. In 2011, Martin Scott published a case report in the British Medical Journal of a 19-year-old man with no significant prior history, other than mild gastroesophageal disease, who presented with chest pain and was found to have a STEMI, according to the ECG and biomarkers. A closer look revealed that, in the week before his admission, he had been consuming large quantities of an energy drink. The authors argued that these energy drinks may have contributed to his presentation.1