A 19-year-old male was brought to the emergency department with rapid palpitations, fever, presyncope and difficulty focussing his vision. He had no chest pain. He admitted ingesting five grams of a substance labelled phenylethylamine, reportedly bought on eBay, and subsequently some cannabis oil to try to relieve the symptoms, which had started following ingestion of phenylethylamine. The fastest recorded heart rate was 126 beats per minute with electrocardiograph showing sinus tachycardia. Blood pressure was 115/70 mmHg with a brief initial temperature of 38 degrees Celsius. Full blood count and routine biochemistry were normal. High-sensitivity Troponin I peaked at 153 ng/L (normal <26), falling to 13 ng/L two days later. He was otherwise well with no history of syncope, significant illnesses, regular medications or significant family history.
The patient was asymptomatic upon review the next day with only intermittent low-atrial pacemaker on telemetry. Inpatient transthoracic echocardiography, and outpatient exercise stress electrocardiography were normal.
Discussion with a toxicologist and online database search revealed minimal literature on cardiac toxicity from phenylethylamine. Phenylethylamine is a natural, trace neuroamine found in the central nervous system, and acts as a neuromodulator, causing release of Dopamine and Norepinephrine. It is found in chocolate and contributes to the stimulating effects of cocoa. It is also a nootropic supplement product.
This case highlights safety issues regarding inadequate regulation of supplements sold online and in retail outlets. Ingestion resulted in myocardial injury, with a troponin rise. Whilst there was co-ingestion of cannabis, significant symptoms started following ingestion of the phenylethylamine.
© 2016 Published by Elsevier Inc.