case report
Wien Klin Wochenschr (2012) 124:285287
DOI 10.1007/s00508-012-0163-8
A case of acute myocardial infarction due to the use
of cayenne pepper pills
Muhammet RasitSayin, TurgutKarabag, Sait
MesutDogan, IbrahimAkpinar, MustafaAydin
Received: 19 December 2011 / Accepted: 28 January 2012 / Published online: 20 April 2012
Springer-Verlag Wien 2012
Akuter Myokardinfarkt als Folge der Einnahme
von Cayenne Pfeffer Pillen: Ein Fallbericht
Zusammenfassung Der Gebrauch von Cayenne Pfeffer
enthaltende Pillen zur Gewichtsabnahme nimmt immer
mehr zu. Der Hauptwirkstoff der Cayenne Pfeffer Pillen
ist Capsaicin, dessen Wirkung auf das kardiovaskulre
System umstritten ist. In der vorliegenden Arbeit stel-
len wir den Fall eines 41-jhrigen mnnlichen Patien-
ten ohne kardiovaskulre Risikofaktoren vor, der zur
Gewichtsabnahme Cayenne Pfeffer Pillen einnahm und
einen akuten Herzinfarkt erlitt.
Schlsselwrter: Capsaicin, Akuter Herzinfarkt
Summary The use of weight loss pills containing cay-
enne pepper has ever been increasing. The main com-
ponent of cayenne pepper pills is capsaicin. There are
conflicting data about the effects of capsaicin on the car-
diovascular system. In this paper, we present the case of
a 41 year old male patient with no cardiovascular risk
factors who took cayenne pepper pills to lose weight and
developed acute myocardial infarction.
Keywords: Capsaicin, Acute coronary syndrome
Introduction
The use of weight loss pills containing cayenne pepper
has ever been increasing. The main component of cay-
enne pepper pills is capsaicin. Capsaicin increases cate-
cholamine secretion from the adrenal medulla through
M. R.Sayin,MD() T.Karabag, MD S. M.Dogan, MD
I.Akpinar, MD M.Aydin, MD
Department of Cardiology, School of Medicine, Zonguldak
Karaelmas University, Kozlu 67600, Zonguldak, Turkey
e-mail: sayinmr@mynet.com
13 A case of acute myocardial infarction due to the use of cayenne pepper pills
Wiener klinische Wochenschrift
The Central European Journal of Medicine
activation of the sympathetic nervous system, which in
turn increases energy expenditure and lipid metabolism
resulting in decreased fat tissue [1, 2]. Activation of the
sympathetic nervous system may exert deleterious meta-
bolic and cardiovascular effects [3]. In this paper, we
present a case of a 41-year-old male patient with no car-
diovascular risk factors who took cayenne pepper pills to
lose weight and developed acute myocardial infarction.
Case report
A 41-year-old male patient with no previous complaints
or disease presented to our emergency department with
squeezing chest pain started 8h ago. He had no known
cardiovascular risk factors. He also had no family history
of coronary artery disease. He reported no exposure to
emotional or physical stress. He had a 3month history of
use of cayenne pepper pills to lose weight. On physical
examination, his blood pressure was 130/80mmHg and
heart rate was 108 beats/min. Cardiovascular and respi-
ratory system examination was normal. Analysis of the
ECGs revealed pathologic Q waves in leads V15; 4mm
ST segment elevation on V2, 3 mm in V3, 2 mm in V4;
1mm ST segment elevation in aVL; 1mm reciprocal ST
segment depression in DII, III, and aVF (Fig. 1). Based
on theese findings, the patient was taken to the coronary
angiography laboratory for primary percutaneous coro-
nary intervention with the diagnosis of acute anterior
myocardial infarction. It was found that the left anterior
descending artery (LAD) was 100 % occluded after the
diagonal branch (Fig. 2). The left circumflex and right
coronary artery were normal (Fig.2). A 3.525mm bare-
metal stent was implanted in the LAD after predilatation
with a 2.515mm balloon catheter. During the follow-up
period, the peak troponin level was>50 ng/ml and the
peak CK-MB was>300ng/ml. The triglyceride level was
38mg/dl, total cholesterol 144mg/dl, LDL 99mg/dl, and
HDL 37 mg/dl. Complete blood count, blood glucose,
285
 case report
Fig. 1 ECG
renal and liver function tests, thyroid function tests, and
coagulation tests were all in the normal range.
The patient who was followed up for 1 week without
any complications was prescribed nebivolol, ramipril,
hydrochlorothiazide, spironolactone, atorvastatine, clo-
pidogrel, acetylsalicylic acid, and pantoprazole, and
discharged from the hospital. The patient was followed
up for one month without any problems.
Discussion
The main component of cayenne pepper pills is capsai-
cin. Capsaicin is the active component of chili peppers,
which are plants belonging to the genus Capsicum. The
use of cayenne pepper pills containing capsaicin for the
purpose of losing weight has ever been increasing. Expe-
rimental studies have shown that intravenous adminis-
tration of extracts of red pepper (capsiate, capsaicin,
etc) leads to catecholamine discharge resulting from the
activation of sympathetic nervous system, as a result of
which it was found that energy expenditure, blood pres-
sure, and heart rate have increased in rats [4]. Human
studies also demonstrated that capsaicin induced the
adrenalin secretion through the activation of sympathe-
tic nervous system and the heart rate and systolic blood
pressure were significantly increased [5, 6]. Evidence has
been also provided that the activation of the sympathetic
Fig. 2 Left and Right coronary
angiography
286 A case of acute myocardial infarction due to the use of cayenne pepper pills
nervous system is peculiar to the essential hypertensive
state, parallels the degree of the blood pressure eleva-
tion, is triggered by reflex and humoral mechanisms,
and may exert deleterious metabolic and cardiovascu-
lar effects, accelerating the progression of the end organ
damage accompanying hypertension [3]. Cases of hyper-
tensive crisis due to ingestion of capsaicin have been
previously reported [7, 8]. Cases of myocardial infarction
due to ingestion of capsaicin have also been previously
reported [8, 9]. One case presented with concomitant
hypertensive crisis [8]; an another case was a 29-year-old
man who presented with acute myocardial infarction [9].
He had no angiographically visible atherosclerothic pla-
que and myocardial infarction was attributed to coronary
vasospasm because of topical capsaisin consumption. In
contrast to this patient, there was an atherosclerothic
plaque in our case and he had been exposed to capsaisin
for a longer time. We believe that capsaisin consumption
might trigger the acute coronary syndrome process con-
tributing to plaque erosion. Another experimental study
has shown that capsaicin causes a decrease in coronary
blood flow due to secondary endothelin release [10].
However, a recent study has shown that oral ingestion
of capsaicinoid has no effects different than placebo on
blood epinephrine and norepinephrine levels, and the
heart rate and blood pressure were not influenced [11].
The patients presented in the mentioned study had been
taking capsaicin for one week whereas the patient in our
case had been taking capsaicin for three months.
In the case presented, the use of chronic capsaicin
might have triggered acute coronary syndrome. Chronic
consumption of these pills may affect plaque rupture with
catecholamine discharge and hypertensive crisis resul-
ting from the activation of sympathetic nervous system.
There may be a vasospastic component due to secondary
endothelin release. Unfortunately, any vasodilator drug
was not administered at the time of the cardiac cather-
ization. It should also be kept in mind that this condition
may be a coincidence. However, in the case presented
young age, absence of cardiovascular risk factors and
any other triggering factors suggest that capsaicin may
lead to adverse cardiac outcomes. Thus, people should
13

be warned about use of this kind of product whose effects
have not been fully elucidated.
Conflict of interest
The authors report no conflict of interest.
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