Table 1.
| Author, Year (Country) | Presentation | Age/Gender | Energy drink & co-ingestions (quantity) | Electrophysiological abnormalities identified | Outcomes |
|---|---|---|---|---|---|
| Zacher et al., 2018 (35) (Germany) | Severe persisting chest pain | 25/M | Various unstated caffeinated energy drinks (~2 l) mixed with strong liquor | ST-segment elevation in leads I, aVL and V1–V4 with corresponding inferior ST-segment depression, as well as in V6 and the dorsal leads | Spontaneous LAD dissection and concomitant occlusion; Drug eluting stent placement with restoration of TIMI 3 flow |
| Ullah et al., 2018 (32) (United States) | Substernal chest pain, shortness of breath, nausea, and vomiting | 25/M | Unstated caffeinated energy drinks (7–9 cans) daily for the past week | ST depression in precordial leads V2–V6 | Normal coronary arteries; symptom free on follow-up |
| Demir et al., 2018 (12) (Turkey) | Tachycardia and feeling of a burning sensation in the chest | 34/M | Red bull (2 boxes) | Wide QRS tachycardia with delta waves | Converted to NSR; radiofrequency ablation of left posterolateral accessory pathway after diagnosis of intermittent WPW syndrome; drug eluting stent placement |
| Choudhury et al., 2017 (11) (United Kingdom) | Abnormal exercise treadmill test | 53/M | Red bull (2 cans) | PVCs and ST changes during exercise treadmill test | Normal exercise treadmill test on repeat testing (with no ED) one week later |
| Enriquez and Frankel, 2017 (15) (United States) | Cardiac arrest | 19/M | Monster (3 cans of 8 oz) | VF | Converted to NSR; full neurologic recovery |
| Syncope | 23/F | Red bull (1 can) | VF | Appropriate shock by AICD; successful conversion to NSR | |
| Hernandez et al., 2016 (17) (United States) | Acute crushing retrosternal chest pressure and shortness of breath | 28/M | Red Bull (4–5 drinks daily × several weeks) | Initial ECG: hyper-acute T waves in leads II, III, aVF, and ST-segment depression in leads I, aVL, V1, and V2 Repeat ECG: 3 mm ST segment elevation with tombstone morphology in leads II, III, aVF, and ST segment depression in I and aVL |
Complete occlusion of mid-RCA; aspiration thrombectomy with TIMI 3 flow |
| Mattioli et al., 2016 and 2018 (20, 21) (Italy) | Precordial oppressive sensation, palpitations, increasing anxiety, and nausea | 22/M | Unstated caffeinated energy drink (750 ml) | AF with ventricular rate of 135 bmp | Converted to NSR |
| Palpitations and anxiety | 23/M | Unstated caffeinated energy drink (600 ml) with recent increase in caffeine intake (400 mg/day) | AF with ventricular rate of 150 bmp | Converted to NSR | |
| Anxiety, nausea, increasing precordial discomfort, and palpitations | 26/M | Unstated caffeinated energy drink (600 ml) with alcoholic beverage (corresponds to 30 g of alcohol) | AF with ventricular rate of 170 bmp | Converted to NSR | |
| Sattari et al., 2016 (27) (United States) | Bloody vomit | 28/M | Monster (2 drinks daily × several months) and beer (2–3 drinks daily × several months) | AF with ventricular rate of 130 bpm | Converted to NSR |
| Khan et al., 2015 (19) (United States) | Unresponsive, pulseless | 27/M | Red Bull (6 drinks daily ×6–8 months) | Initial ECG: VT ECG after shock: non-specific ST-T wave changes; QTc 469 ms Repeat ECG: borderline lateral ST elevation |
Converted to NSR; normal coronary arteries |
| Solomin et al., 2015 (30) (United States) | Left-sided chest pain | 26/M | Monster, Rock Star, and other similar brands of energy drink (~4 L/day, duration unspecified) | ST elevation in inferior leads with reciprocal changes in anterior leads | Complete occlusion of left circumflex artery; drug-eluting stent placement with resolution of ST elevation |
| Unal et al., 2015 (31) (Turkey) | Retrosternal chest pain, palpitations, and emesis | 32/M | Unstated energy drink (5 bottles) | ST elevation V2 through V6 | Left main and proximal LAD thrombus; no atherosclerotic lesions or coronary malformations; LAD balloon angioplasty with proximal LAD flow; discharged home with DAPT |
| Shah et al., 2014 (29) (United States) | QTc prolongation | 31/M | Phase A: Monster (32 oz) Phase B: carbonated water (16 oz) twice daily ×7 days (total daily volume was consumed together for one of the 7 days) followed by Monster (16 oz) twice daily ×7 days |
Phase A: maximum observed change in QTc = 25 ms Phase B: maximum post-dosing change in QTc from placebo QTc = 22 ms; no VT, SVT, AF, or AV block |
QTc prolongation resolved without intervention |
| Ward et al., 2014 (33) (United States) | First AICD shock | 45/M | Red bull (3 drinks) | Non-sustained VT/VF | Fatal arrhythmia prevented by AICD shock |
| Avci et al., 2013 (7) (Turkey) | Loss of consciousness/cardiac arrest | 28/M | Unstated caffeinated energy drink (750 ml, 250 ml daily ×7 months) | VT | Converted to NSR, followed by SCD 3 days later |
| Polat et al., 2013 (24) (Turkey) | Crushing, mid-sternal chest pain | 13/M | Unstated caffeinated energy drink (volume unstated) | 2 to 3 mm ST segment elevation in leads II, III, aVF, and V3–V5 | Spontaneous LAD dissection with visible tear; discharged home after medical treatment |
| Benjo et al., 2012 (8) (United States) | Nausea, multiple episodes of emesis, palpitations, and severe retrosternal chest pain | 24/M | Unstated energy drink mixed with vodka (3 drinks) | Initial ECG: NSR with subtle J-point elevation in leads II, III, aVF, and V2–V6 with a concave shape Repeat ECG: ST elevation and a convex shape in the lateral leads, with a decrease in R-wave progression |
Left main (involving the origin of the circumflex) and LAD thrombus with no atherosclerotic lesions or coronary malformations; Discharged home after CABG |
| Dufendach et al., 2012 (14) (United States) | Palpitations, chest pain, shakiness, dizziness | 13/F | Unstated caffeinated energy drink (≥16 oz every other day ×2 weeks) | QT/QTc = 420/561 ms | Diagnosis of LQT1; normal QTc |
| Hanan Israelit et al., 2012 (16) (Israel) | Crushing chest pain, nausea, vomiting | 24/M | Unstated caffeinated energy drink (XL, 20 cans); MDMA | Initial ECG: widespread ST segment elevation While waiting for catheterization: wide complex tachycardia, which further deteriorated to VF |
Death |
| Kaoukis et al., 2012 (18) (Greece) | Chest pain, acute respiratory failure, palpitations | 24/M | Unstated caffeinated energy drink (volume unstated) | SVT; VT; sinus tachycardia; mildly elevated troponin; LVEF = 35%; elevated BNP | Diagnosis of reverse takotsubo cardiomyopathy |
| Mugmon (2012) (United States) | Lightheadedness and palpitations | 26/M | 5-h energy drink (138 mg caffeine, volume unknown) with mixed amphetamine salts | Atrial flutter with 1:1 conduction and aberrant conduction (300 bpm); AF and other atrial arrhythmias | Successful ablation |
| Rottlaender et al., 2012 (25) (Germany) | Cardiac arrest | 22/F | Unstated caffeinated [480 mg] energy drink (6 cans) | TdP degenerated to VF; QT/QTc = 526/492 ms | Diagnosis of LQT1; normal QTc; no coronary anomalies |
| Rutledge et al., 2012 (26) (United States) | Collapse | 24/M | Red bull with vodka (a few sips) | VF; R' with ST segment elevation in V1 and V2 | Converted to NSR; diagnosis of Brugada syndrome; discharged with AICD |
| Wilson et al., 2012 (34) (United States) | Acute chest pain | 17/M | Red Bull (3–4 cans) and Monster (2–3 cans) | Diffuse ST elevation in leads II, III, AVF, V3–V6, and ST segment depression in leads AVR and V1 | Spontaneous normalization of ECG; diagnosis of acute coronary artery vasospasm |
| Di Rocco et al., 2011 (13) (United States) | Persistent heart fluttering | 14/M | Unstated caffeinated drink day prior (volume unknown) | AF with occasional atrial flutter | Converted to NSR |
| Intoxication and vomiting | 16/M | Red Bull with vodka (volumes unknown); amphetamine and dextroamphetamine 30 mg/day at home | Atrial tachycardia; AF with RVR | Converted to NSR | |
| Scott et al., 2011 (28) (United Kingdom) | Acute chest pain | 19/M | Red Bull (2–3 cans daily ×1 week) | 2 mm ST segment elevation in leads I, II, aVL and V4–V6, with 2 mm ST depression in leads V1 and V2 | Normal coronary arteries |
| Berger and Alford, 2009 (9) (Australia) | Cardiac arrest | 28/M | Unstated caffeinated energy drink (7–8 cans) | Initial ECG: VF ECG on arrival at hospital: elevated anteroseptal ST segments with reciprocal inferior ST depression |
Converted to NSR; normal coronary arteries |
| Nagajothi et al., 2008 (23) (United States) | Palpitations and chest tightness | 23/F | GNC Speed Shot; Mountain Dew soda (volumes unstated) | Narrow complex tachycardia | Converted to NSR |
| Cannon et al., 2001 (10) (Australia) | Collapse | 25/F | Race 2005 Energy Blast (55 ml) | VF | Death |
AF, atrial fibrillation; AICD, automated implantable cardioverter defibrillator; AV, atrioventricular; bpm, beats per minute; CABG, coronary artery bypass grafting; DAPT, dual antiplatelet therapy; ECG, electrocardiogram; ED, energy drink; LAD, left anterior descending; LQTS1, long QT type 1; MDMA, 3,4-methylenedioxymethamphetamine; NSR, normal sinus rhythm; PVC, premature ventricular contraction; RCA, right coronary artery; RVR, rapid ventricular response; SCD, sudden cardiac death; ST, sinus tachycardia; STEMI, ST-elevation myocardial infarction; SVT, supraventricular arrhythmia; TdP, torsades de pointes; VF, ventricular fibrillation; VT, ventricular tachycardia; WPW, Wolff-Parkinson-White.