JACC Case Rep. 2026 May 14:108361. doi: 10.1016/j.jaccas.2026.108361. Online ahead of print.
ABSTRACT
BACKGROUND: Bitter orange (Citrus aurantium) is a common ingredient in weight-loss supplements and contains p-synephrine, a proto-alkaloid with sympathomimetic properties. Various cardiovascular adverse events have been reported after its use.
CASE SUMMARY: A 38-year-old woman without cardiovascular risk factors presented with palpitations, atypical chest pain, and vomiting after 1 week of weight-loss-supplement use. Electrocardiography showed a supraventricular tachycardia, successfully terminated with 6 mg of intravenous adenosine. High-sensitivity troponin I rose from 17.9 to 1,395.7 ng/L. Transthoracic echocardiography was unremarkable, computed tomography pulmonary angiography excluded pulmonary embolism, and coronary angiography showed no obstructive coronary artery disease. Cardiac magnetic resonance demonstrated nonspecific late gadolinium enhancement.
DISCUSSION: This case highlights a possible association between bitter orange supplement use and supraventricular tachycardia with myocardial injury in the absence of obstructive coronary disease. The likely mechanism involves p-synephrine-mediated sympathetic stimulation, with possible demand ischemia and/or vasospasm.
PMID:42132724 | DOI:10.1016/j.jaccas.2026.108361