Myocardial Infarction in an Adolescent Fontan Patient Who Consumed Energy Drinks on a Daily Basis and Stopped Thromboprophylaxis: A Case Report

Christoph Bauer; Natascha Pramhofer; Mouhamad El Haj-Moustafa; Gerald Tulzer

doi:doi:10.11648/j.ccr.20210502.20

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Myocardial Infarction in an Adolescent Fontan Patient Who Consumed Energy Drinks on a Daily Basis and Stopped Thromboprophylaxis: A Case Report

Christoph Bauer, Natascha Pramhofer, Mouhamad El Haj-Moustafa, Gerald Tulzer

Published in Cardiology and Cardiovascular Research (Volume 5, Issue 2)

Received: 6 May 2021 Accepted: 26 May 2021 Published: 26 June 2021

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Abstract

Patients with single ventricle type congenital heart disease show a variety of risk factors for thromboembolic complications leading to stroke, pulmonary embolism and rarely myocardial ischemia. Energy drink consumption has been associated with adverse effects on vascular function and coagulation and may increase the risk. We report a case of a 14-year-old Fontan patient who presented with new onset cyanosis, chest pain and syncope. He quitted antiplatelet therapy himself three years ago and consumed three energy drinks a day regularly. On admission cardiac enzymes were severely elevated ECG showed slightly elevated ST-segments and Echo demonstrated reduced function. Myocarditis was first suspected but was rejected after MRI depicted a large transmural scar. During cardiac catheterization a total occlusion of the entire right coronary artery leading to myocardial infarction was found. The patient was put on dual anticoagulation and scheduled for transplantation because of severe myocardial impairment but did not consent and ultimately died. Myocardial infarction is an extremely rare complication in the Fontan population that has to be considered and ruled out in a timely manner in patients who present with chest pain and elevated troponin T to preserve ventricular function. Continuous thromboprophylaxis and avoidance of additional risk factors like energy drinks is warranted to prevent thromboembolic events in this population.

Published in	Cardiology and Cardiovascular Research (Volume 5, Issue 2)
DOI	10.11648/j.ccr.20210502.20
Page(s)	125-128
Creative Commons	This is an Open Access article, distributed under the terms of the Creative Commons Attribution 4.0 International License (http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution and reproduction in any medium or format, provided the original work is properly cited.
Copyright	Copyright © The Author(s), 2024. Published by Science Publishing Group

Keywords

Myocardial Infarction, Fontan Circulation, Energy Drink, Antiplatelet Therapy, Adolescent, Case Report

References

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[2]	Roeleveld PP, Axelrod DM, Klugman D, Jones MB, Chanani NK, Rossano JW, et al. Hypoplastic left heart syndrome: from fetus to fontan. Cardiol Young. 2018 Nov; 28 (11): 1275–88.
[3]	Chugh R. The Fontan Thromboprophylaxis Dilemma. Journal of the American College of Cardiology. 2019 Aug; 74 (8): 1082–5.
[4]	Rychik J, Atz AM, Celermajer DS, Deal BJ, Gatzoulis MA, Gewillig MH, et al. Evaluation and Management of the Child and Adult with Fontan Circulation: A Scientific Statement From the American Heart Association. Circulation [Internet]. 2019 Aug 6 [cited 2021 May 6]; 140 (6). Available from: https://www.ahajournals.org/doi/10.1161/CIR.0000000000000696.
[5]	Deshaies C, Hamilton RM, Shohoudi A, Trottier H, Poirier N, Aboulhosn J, et al. Thromboembolic Risk After Atriopulmonary, Lateral Tunnel, and Extracardiac Conduit Fontan Surgery. Journal of the American College of Cardiology. 2019 Aug; 74 (8): 1071–81.
[6]	Misra A, Gayanilo M, Gupta P. Coronary artery embolism in a patient with Fontan palliation: a rare complication. Cardiol Young. 2020 Jul; 30 (7): 1029–31.
[7]	Somers KR, Svatikova A. Cardiovascular and Autonomic Responses to Energy Drinks—Clinical Implications. JCM. 2020 Feb 5; 9 (2): 431.
[8]	Pommerening MJ, Cardenas JC, Radwan ZA, Wade CE, Holcomb JB, Cotton BA. Hypercoagulability after energy drink consumption. Journal of Surgical Research. 2015 Dec; 199 (2): 635–40.
[9]	Higgins JP, Babu K, Deuster PA, Shearer J. Energy Drinks: A Contemporary Issues Paper. Curr Sports Med Rep. 2018 Feb; 17 (2): 65–72.
[10]	Lippi G, Cervellin G, Sanchis-Gomar F. Energy Drinks and Myocardial Ischemia: A Review of Case Reports. Cardiovasc Toxicol. 2016 Jul; 16 (3): 207–12.
[11]	Mangi MA, Rehman H, Rafique M, Illovsky M. Energy Drinks and the Risk of Cardiovascular Disease: A Review of Current Literature. Cureus. 2017 Jun 7; 9 (6): e1322.
[12]	Small AJ, Aboulhosn JA, Lluri G. Thromboprophylaxis in Adults with Atrio-Pulmonary Fontan. World J Pediatr Congenit Heart Surg. 2018; 9 (5): 504–8.
[13]	Firdouse M, Agarwal A, Chan AK, Mondal T. Thrombosis and Thromboembolic Complications in Fontan Patients: A Literature Review. Clin Appl Thromb Hemost. 2014 Jul; 20 (5): 484–92.
[14]	Worthley MI, Prabhu A, De Sciscio P, Schultz C, Sanders P, Willoughby SR. Detrimental effects of energy drink consumption on platelet and endothelial function. Am J Med. 2010 Feb; 123 (2): 184–7.
[15]	Israelit SH, Strizevsky A, Raviv B. ST elevation myocardial infarction in a young patient after ingestion of caffeinated energy drink and ecstasy. World Journal of Emergency Medicine. 2012; 3 (4): 305.
[16]	Hill D, Waldman A, Vivek D. A 16-year-old with ST elevation myocardial infarction: case report and review of the literature. Cardiol Young. 2016 Feb; 26 (2): 230–6.
[17]	Subahi A, Forbes T, Ali OE. Percutaneous coronary intervention following Fontan procedure. IJC Heart & Vasculature. 2020 Jun; 28: 100511.

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APA Style

Christoph Bauer, Natascha Pramhofer, Mouhamad El Haj-Moustafa, Gerald Tulzer. (2021). Myocardial Infarction in an Adolescent Fontan Patient Who Consumed Energy Drinks on a Daily Basis and Stopped Thromboprophylaxis: A Case Report. Cardiology and Cardiovascular Research, 5(2), 125-128. https://doi.org/10.11648/j.ccr.20210502.20

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ACS Style

Christoph Bauer; Natascha Pramhofer; Mouhamad El Haj-Moustafa; Gerald Tulzer. Myocardial Infarction in an Adolescent Fontan Patient Who Consumed Energy Drinks on a Daily Basis and Stopped Thromboprophylaxis: A Case Report. Cardiol. Cardiovasc. Res. 2021, 5(2), 125-128. doi: 10.11648/j.ccr.20210502.20

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AMA Style

Christoph Bauer, Natascha Pramhofer, Mouhamad El Haj-Moustafa, Gerald Tulzer. Myocardial Infarction in an Adolescent Fontan Patient Who Consumed Energy Drinks on a Daily Basis and Stopped Thromboprophylaxis: A Case Report. Cardiol Cardiovasc Res. 2021;5(2):125-128. doi: 10.11648/j.ccr.20210502.20

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@article{10.11648/j.ccr.20210502.20,
  author = {Christoph Bauer and Natascha Pramhofer and Mouhamad El Haj-Moustafa and Gerald Tulzer},
  title = {Myocardial Infarction in an Adolescent Fontan Patient Who Consumed Energy Drinks on a Daily Basis and Stopped Thromboprophylaxis: A Case Report},
  journal = {Cardiology and Cardiovascular Research},
  volume = {5},
  number = {2},
  pages = {125-128},
  doi = {10.11648/j.ccr.20210502.20},
  url = {https://doi.org/10.11648/j.ccr.20210502.20},
  eprint = {https://article.sciencepublishinggroup.com/pdf/10.11648.j.ccr.20210502.20},
  abstract = {Patients with single ventricle type congenital heart disease show a variety of risk factors for thromboembolic complications leading to stroke, pulmonary embolism and rarely myocardial ischemia. Energy drink consumption has been associated with adverse effects on vascular function and coagulation and may increase the risk. We report a case of a 14-year-old Fontan patient who presented with new onset cyanosis, chest pain and syncope. He quitted antiplatelet therapy himself three years ago and consumed three energy drinks a day regularly. On admission cardiac enzymes were severely elevated ECG showed slightly elevated ST-segments and Echo demonstrated reduced function. Myocarditis was first suspected but was rejected after MRI depicted a large transmural scar. During cardiac catheterization a total occlusion of the entire right coronary artery leading to myocardial infarction was found. The patient was put on dual anticoagulation and scheduled for transplantation because of severe myocardial impairment but did not consent and ultimately died. Myocardial infarction is an extremely rare complication in the Fontan population that has to be considered and ruled out in a timely manner in patients who present with chest pain and elevated troponin T to preserve ventricular function. Continuous thromboprophylaxis and avoidance of additional risk factors like energy drinks is warranted to prevent thromboembolic events in this population.},
 year = {2021}
}

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TY  - JOUR
T1  - Myocardial Infarction in an Adolescent Fontan Patient Who Consumed Energy Drinks on a Daily Basis and Stopped Thromboprophylaxis: A Case Report
AU  - Christoph Bauer
AU  - Natascha Pramhofer
AU  - Mouhamad El Haj-Moustafa
AU  - Gerald Tulzer
Y1  - 2021/06/26
PY  - 2021
N1  - https://doi.org/10.11648/j.ccr.20210502.20
DO  - 10.11648/j.ccr.20210502.20
T2  - Cardiology and Cardiovascular Research
JF  - Cardiology and Cardiovascular Research
JO  - Cardiology and Cardiovascular Research
SP  - 125
EP  - 128
PB  - Science Publishing Group
SN  - 2578-8914
UR  - https://doi.org/10.11648/j.ccr.20210502.20
AB  - Patients with single ventricle type congenital heart disease show a variety of risk factors for thromboembolic complications leading to stroke, pulmonary embolism and rarely myocardial ischemia. Energy drink consumption has been associated with adverse effects on vascular function and coagulation and may increase the risk. We report a case of a 14-year-old Fontan patient who presented with new onset cyanosis, chest pain and syncope. He quitted antiplatelet therapy himself three years ago and consumed three energy drinks a day regularly. On admission cardiac enzymes were severely elevated ECG showed slightly elevated ST-segments and Echo demonstrated reduced function. Myocarditis was first suspected but was rejected after MRI depicted a large transmural scar. During cardiac catheterization a total occlusion of the entire right coronary artery leading to myocardial infarction was found. The patient was put on dual anticoagulation and scheduled for transplantation because of severe myocardial impairment but did not consent and ultimately died. Myocardial infarction is an extremely rare complication in the Fontan population that has to be considered and ruled out in a timely manner in patients who present with chest pain and elevated troponin T to preserve ventricular function. Continuous thromboprophylaxis and avoidance of additional risk factors like energy drinks is warranted to prevent thromboembolic events in this population.
VL  - 5
IS  - 2
ER  -

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Author Information

Christoph Bauer

Department of Paediatric Cardiology, Kepler University Hospital GmbH, Linz, Austria
Natascha Pramhofer

Department of Paediatric Cardiology, Kepler University Hospital GmbH, Linz, Austria
Mouhamad El Haj-Moustafa

Department of Paediatric Cardiology, Kepler University Hospital GmbH, Linz, Austria
Gerald Tulzer

Department of Paediatric Cardiology, Kepler University Hospital GmbH, Linz, Austria

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Plain Text BibTeX RIS

APA Style

Christoph Bauer, Natascha Pramhofer, Mouhamad El Haj-Moustafa, Gerald Tulzer. (2021). Myocardial Infarction in an Adolescent Fontan Patient Who Consumed Energy Drinks on a Daily Basis and Stopped Thromboprophylaxis: A Case Report. Cardiology and Cardiovascular Research, 5(2), 125-128. https://doi.org/10.11648/j.ccr.20210502.20

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ACS Style

Christoph Bauer; Natascha Pramhofer; Mouhamad El Haj-Moustafa; Gerald Tulzer. Myocardial Infarction in an Adolescent Fontan Patient Who Consumed Energy Drinks on a Daily Basis and Stopped Thromboprophylaxis: A Case Report. Cardiol. Cardiovasc. Res. 2021, 5(2), 125-128. doi: 10.11648/j.ccr.20210502.20

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AMA Style

Christoph Bauer, Natascha Pramhofer, Mouhamad El Haj-Moustafa, Gerald Tulzer. Myocardial Infarction in an Adolescent Fontan Patient Who Consumed Energy Drinks on a Daily Basis and Stopped Thromboprophylaxis: A Case Report. Cardiol Cardiovasc Res. 2021;5(2):125-128. doi: 10.11648/j.ccr.20210502.20

Copy | Download

@article{10.11648/j.ccr.20210502.20,
  author = {Christoph Bauer and Natascha Pramhofer and Mouhamad El Haj-Moustafa and Gerald Tulzer},
  title = {Myocardial Infarction in an Adolescent Fontan Patient Who Consumed Energy Drinks on a Daily Basis and Stopped Thromboprophylaxis: A Case Report},
  journal = {Cardiology and Cardiovascular Research},
  volume = {5},
  number = {2},
  pages = {125-128},
  doi = {10.11648/j.ccr.20210502.20},
  url = {https://doi.org/10.11648/j.ccr.20210502.20},
  eprint = {https://article.sciencepublishinggroup.com/pdf/10.11648.j.ccr.20210502.20},
  abstract = {Patients with single ventricle type congenital heart disease show a variety of risk factors for thromboembolic complications leading to stroke, pulmonary embolism and rarely myocardial ischemia. Energy drink consumption has been associated with adverse effects on vascular function and coagulation and may increase the risk. We report a case of a 14-year-old Fontan patient who presented with new onset cyanosis, chest pain and syncope. He quitted antiplatelet therapy himself three years ago and consumed three energy drinks a day regularly. On admission cardiac enzymes were severely elevated ECG showed slightly elevated ST-segments and Echo demonstrated reduced function. Myocarditis was first suspected but was rejected after MRI depicted a large transmural scar. During cardiac catheterization a total occlusion of the entire right coronary artery leading to myocardial infarction was found. The patient was put on dual anticoagulation and scheduled for transplantation because of severe myocardial impairment but did not consent and ultimately died. Myocardial infarction is an extremely rare complication in the Fontan population that has to be considered and ruled out in a timely manner in patients who present with chest pain and elevated troponin T to preserve ventricular function. Continuous thromboprophylaxis and avoidance of additional risk factors like energy drinks is warranted to prevent thromboembolic events in this population.},
 year = {2021}
}

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TY  - JOUR
T1  - Myocardial Infarction in an Adolescent Fontan Patient Who Consumed Energy Drinks on a Daily Basis and Stopped Thromboprophylaxis: A Case Report
AU  - Christoph Bauer
AU  - Natascha Pramhofer
AU  - Mouhamad El Haj-Moustafa
AU  - Gerald Tulzer
Y1  - 2021/06/26
PY  - 2021
N1  - https://doi.org/10.11648/j.ccr.20210502.20
DO  - 10.11648/j.ccr.20210502.20
T2  - Cardiology and Cardiovascular Research
JF  - Cardiology and Cardiovascular Research
JO  - Cardiology and Cardiovascular Research
SP  - 125
EP  - 128
PB  - Science Publishing Group
SN  - 2578-8914
UR  - https://doi.org/10.11648/j.ccr.20210502.20
AB  - Patients with single ventricle type congenital heart disease show a variety of risk factors for thromboembolic complications leading to stroke, pulmonary embolism and rarely myocardial ischemia. Energy drink consumption has been associated with adverse effects on vascular function and coagulation and may increase the risk. We report a case of a 14-year-old Fontan patient who presented with new onset cyanosis, chest pain and syncope. He quitted antiplatelet therapy himself three years ago and consumed three energy drinks a day regularly. On admission cardiac enzymes were severely elevated ECG showed slightly elevated ST-segments and Echo demonstrated reduced function. Myocarditis was first suspected but was rejected after MRI depicted a large transmural scar. During cardiac catheterization a total occlusion of the entire right coronary artery leading to myocardial infarction was found. The patient was put on dual anticoagulation and scheduled for transplantation because of severe myocardial impairment but did not consent and ultimately died. Myocardial infarction is an extremely rare complication in the Fontan population that has to be considered and ruled out in a timely manner in patients who present with chest pain and elevated troponin T to preserve ventricular function. Continuous thromboprophylaxis and avoidance of additional risk factors like energy drinks is warranted to prevent thromboembolic events in this population.
VL  - 5
IS  - 2
ER  -

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