Pre-workout Induced Demand Ischemia

Area of Science:

• Cardiology
• Sports Medicine
• Toxicology

Background:

• Increasing use of pre-workout supplements (PWS) in fitness communities.
• Reported cases of adverse events and undeclared substances in PWS.
• Need for awareness regarding potential cardiac complications associated with PWS.

Observation:

• A 35-year-old patient presented with sinus tachycardia, elevated troponin, and subclinical hyperthyroidism after initiating PWS.
• Echocardiogram revealed normal ejection fraction and no wall motion abnormalities.
• Patient refused beta-blocker therapy (propranolol).

Findings:

• Symptoms and elevated troponin levels resolved within 36 hours with hydration.
• Subclinical hyperthyroidism and sinus tachycardia also improved.
• Cardiac injury was deemed reversible.

Implications:

• Highlights the importance of considering PWS as a potential cause of cardiac injury in young, active individuals.
• Emphasizes the need for thorough patient history, including supplement use, when evaluating chest pain.
• Suggests that identifying and avoiding off-label substances in over-the-counter supplements is critical for preventing adverse cardiovascular events.