Acute myocardial infarction and coronary vasospasm associated with the ingestion of cayenne pepper pills in a 25-year-old male

For slimming, the use of weight loss pills flavored with Mexican pepper seeds is common among females. Originally called "La Jiao Shou Shen," cayenne (chili) pepper pills have been imported to Turkey from the Far East. China and Russia are the only countries in the world where chili pepper pills are sold. Capsules containing 400 and 600 mg of chili pepper are sold for weight loss; patches and gels are used for pain relief and slimming, respectively [1].Cayenne pepper pills contain pungent ingredients called capsaicinoids, and one of the active components of cayenne pepper is capsaicin [2]. Capsaicin accelerates energy expenditure and suppresses body fat accumulation by activating the sympathetic nervous system (SNS) in animals and humans [3-6]. However, this substance is associated with cardiotoxicity, including coronary vasospasm, supraventricular tachycardia, and acute atrial fibrillation [1,7]. Capsaicin also prolongs the cardiac action potential in atrial and ventricular myocytes, an effect that is associated with the inhibition of potassium currents [8,9]. Coronary vasospasm and acute myocardial infarction (AMI) associated with the use of topical capsaicin patches to relieve back pain have been reported recently [7]. Here, we describe the first reported case of coronary vasospasm and AMI suspected of being caused by the use of cayenne pepper pills for slimming.A 25-year-old male was admitted to our emergency department complaining of severe chest pain 2 h after its onset. The pain radiated to the ulnar aspect of the patient's left arm, neck, and jaw. An electrocardiogram (ECG) demonstrated an ST-segment elevation of 7 mm in leads II, III, and aVF, consistent with an inferior wall AMI (Figure 1). A bedside transthoracic echocardiogram showed a non-dilated left ventricle with inferior hypokinesia, confirming a recent myocardial infarction. On physical examination, the patient was conscious but extremely anxious. His blood pressure was 90/55 mmHg, pulse rate 62 be