American Journal of Medical Case Reports
ISSN (Print): 2374-2151 ISSN (Online): 2374-216X Website: http://www.sciepub.com/journal/ajmcr Editor-in-chief: Samy, I. McFarlane
Open Access
Journal Browser
Go
American Journal of Medical Case Reports. 2019, 7(11), 271-273
DOI: 10.12691/ajmcr-7-11-2
Open AccessCase Report

Yohimbine Induced Type II Myocardial Injury: An Underrecognized and Dangerous Adverse Effect

Jeffrey Song1, and Tariq Sharman1

1Department of Medicine, Heritage College of Osteopathic Medicine at Ohio University, Southern Ohio Medical Center, Portsmouth, Ohio, U.S.A.

Pub. Date: August 14, 2019

Cite this paper:
Jeffrey Song and Tariq Sharman. Yohimbine Induced Type II Myocardial Injury: An Underrecognized and Dangerous Adverse Effect. American Journal of Medical Case Reports. 2019; 7(11):271-273. doi: 10.12691/ajmcr-7-11-2

Abstract

Yohimbine is an Indoloquinolizidine alkaloid derived from the bark of the African tree Pausinystalia johimbe, as well as from the bark of the unrelated South American tree Aspidosperma quebracho-blanco. It is commonly sold as a dietary supplement for the purpose of enhancing libido, weight loss and natural bodybuilding aids. Yohimbine has high affinity for the α2-adrenergic receptor, moderate affinity for the α1 receptor, dopamine D2 receptor, and weak affinity for the dopamine D3 receptors and some of the serotonin receptors. Depending on dosage, Yohimbine can either increase or decrease systemic blood pressure (through vasoconstriction or vasodilation, respectively). We present a 51-year-old male who presented with substernal chest pressure and the sensation of a “pounding heart” after starting Yohimbine as a dietary supplement. He was found to have type II myocardial injury characterized by elevated troponin levels. We propose that the mechanism for this was 1) elevation of blood pressure and sinus tachycardia causing myocardial ischemia due to increased myocardial oxygen demand and supply mismatch, 2) cardiac norepinephrine release causing direct non-ischemic norepinephrine mediated myocardial injury and 3) increased sympathetic outflow mediated coronary vasoconstriction and spasm causing ischemia.

Keywords:
Yohimbine Hypertension Norepinephrine α2 receptor Type II NSTEMI Tachycardia Erectile Dysfunction

Creative CommonsThis work is licensed under a Creative Commons Attribution 4.0 International License. To view a copy of this license, visit http://creativecommons.org/licenses/by/4.0/

References:

[1]  Sun J, Baker A, Chen P (September 2011). "Profiling the indole alkaloids in yohimbe bark with ultra-performance liquid chromatography coupled with ion mobility quadrupole time-of-flight mass spectrometry". Rapid Communications in Mass Spectrometry. 25 (18): 2591-602.
 
[2]  Cohen PA, Wang YH, Maller G, DeSouza R, Khan IA (2015). "Pharmaceutical quantities of yohimbine found in dietary supplements in the USA". Drug Testing and Analysis. 8 (3-4): 357-69.
 
[3]  EFSA Panel on Food Additives and Nutrient Sources Added to Food (ANS) (2013). "Scientific Opinion on the evaluation of the safety in use of Yohimbe (Pausinystalia yohimbe (K. Schum.) Pierre ex Beille". EFSA Journal. 11 (7): 1-46.
 
[4]  Millan MJ, Newman-Tancredi A, Audinot V, Cussac D, Lejeune F, Nicolas JP, et al. (February 2000). "Agonist and antagonist actions of yohimbine as compared to fluparoxan at alpha(2)-adrenergic receptors (AR)s, serotonin (5-HT)(1A), 5-HT(1B), 5-HT(1D) and dopamine D(2) and D(3) receptors. Significance for the modulation of frontocortical monoaminergic transmission and depressive states". Synapse. 35 (2): 79-95.
 
[5]  Arthur JM, Casañas SJ, Raymond JR (June 1993). "Partial agonist properties of rauwolscine and yohimbine for the inhibition of adenylyl cyclase by recombinant human 5-HT1A receptors". Biochemical Pharmacology. 45 (11): 2337-41.
 
[6]  Baxter GS, Murphy OE, Blackburn TP (May 1994). "Further characterization of 5-hydroxytryptamine receptors (putative 5-HT2B) in rat stomach fundus longitudinal muscle". British Journal of Pharmacology. 112 (1): 323-31.
 
[7]  Tam SW, Worcel M, Wyllie M (2001). "Yohimbine: a clinical review". Pharmacology and Therapeutics. 91 (3): 239
 
[8]  Morales A (March 2000). "Yohimbine in erectile dysfunction: the facts". review. International Journal of Impotence Research. 12 (Suppl 1): S70-74.
 
[9]  Andersson KE (September 2001). "Pharmacology of penile erection". Review. Pharmacological Reviews. 53 (3): 417-50.
 
[10]  Thygesen K, Alpert JS, Jaffe AS, et al. Third universal definition of myocardial infarction. Circulation. 2012; 126: 2020–35.
 
[11]  Wang Y, Yu X, Wang F, et al. Yohimbine promotes cardiac NE release and prevents LPS-induced cardiac dysfunction via blockade of presynaptic α2A-adrenergic receptor. PloS one. 2013; 8(5): e63622.
 
[12]  Januzzi JL, Jr, Filippatos G, Nieminen M, Gheorghiade M. Troponin elevation in patients with heart failure: On behalf of the third universal definition of myocardial infarction global task force: Heart failure section. Eur Heart J. 2012; 33(18): 2265-2271.
 
[13]  Woodman OL, Vatner SF (1987). Coronary vasoconstriction mediated by α1- and α2-adrenoceptors in conscious dogs. Am. J. Physiol. 253 (2 Pt 2): H388-93.