© 2005 European Society of Cardiology
A case of fatal ephedra intake associated with lipofuscin accumulation, caspase activation and cleavage of myofibrillary proteins
a Division of Cardiology, VA Medical Center University of Michigan, Ann Arbor, MI, USA
b Department of Histopathology, Royal Free and University College Medical School University College London, London, UK
c Divisions of and Cardiology, St John Hospital Wayne State University, Detroit, MI, USA
d Divisions of Pathology, St John Hospital Wayne State University, Detroit, MI, USA
e Divisions of Internal Medicine, St John Hospital Wayne State University, Detroit, MI, USA
f Institute of Child Health University College London, London, UK
* Corresponding author. Tel.: +1 734 769 7100x5425; fax: +1 413 473 9027. E-mial address: cchensc{at}med.umich.edu
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Abstract |
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Ephedra, a herb reported to suppress appetite and stimulate the sympathetic nervous system as well as cardiac performance, has recently been related to several adverse events, including seizure, stroke, hypertension, myocardial infarction, and sudden death. Here, we describe the case of a 45-year-old woman who died of cardiovascular collapse while taking ephedra. Tissue analysis revealed non-specific degenerative alterations in the myocardium (lipofuscin accumulation, basophilic degeneration and vacuolation of myocytes, as well as myofibrillary loss), associated with myocyte apoptosis, caspase activation, and extensive cleavage of miofibrillary proteins 
-actin, -actinin, and cardiac troponin T. Healthcare professionals are therefore urged to warn their patients about the risk of serious adverse effects, which may follow ephedra intake.
Key Words: Ephedra • Lipofuscin accumulation • Caspase activation • Cleavage of myofibrillary proteins
Received April 22, 2004; Revised July 17, 2004; Accepted September 20, 2004