Unexplained Supraventricular Tachycardia and Myocardial Injury After Bitter Orange Supplement Use in a Young Woman

Bitter orange (Citrus aurantium) is a common ingredient in weight-loss supplements and contains p-synephrine, a proto-alkaloid with sympathomimetic properties. Various cardiovascular adverse events have been reported after its use.

A 38-year-old woman without cardiovascular risk factors presented with palpitations, atypical chest pain, and vomiting after 1 week of weight-loss-supplement use. Electrocardiography showed a supraventricular tachycardia, successfully terminated with 6 mg of intravenous adenosine. High-sensitivity troponin I rose from 17.9 to 1,395.7 ng/L. Transthoracic echocardiography was unremarkable, computed tomography pulmonary angiography excluded pulmonary embolism, and coronary angiography showed no obstructive coronary artery disease. Cardiac magnetic resonance demonstrated nonspecific late gadolinium enhancement.

This case highlights a possible association between bitter orange supplement use and supraventricular tachycardia with myocardial injury in the absence of obstructive coronary disease. The likely mechanism involves p-synephrine-mediated sympathetic stimulation, with possible demand ischemia and/or vasospasm.