Are Energy Drinks Causing This Man's Shortness of Breath?

ANSWER

The ECG reveals atrial flutter with a nonspecific T-wave abnormality. The atrial rate is 300 beats/min. The ventricular rate is 84 beats/min; hence the atrial flutter occurs in a 4:1 pattern. (This is best seen in lead V1, where one of the atrial beats is “hidden” in the QRS complex.) The PR interval of 208 ms on the computerized analysis is misleading and illustrates the risk of relying on the computer for a diagnosis. The nonspecific T-wave abnormalities are best seen in leads V2 and V3 and are of no consequence.

While there are no definitive studies that prove that combining energy drinks containing taurine with beverages containing caffeine increases the risk for arrhythmias, there are several anecdotal case reports. In addition to consumption of taurine- and caffeine-containing beverages, this patient is under a significant amount of stress, producing a large catecholaminergic response.

The patient has no prior cardiac history of arrhythmias and no prior cardiac workup. He underwent synchronized cardioversion to restore normal sinus rhythm and was scheduled for an outpatient workup for structural heart disease.