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To the Editor: A young, previously healthy bodybuilder suffered an acute myocardial infarction in the absence of known cardiovascular risk factors or demonstrable atherosclerotic plaque. The infarction probably resulted from coronary spasm, platelet activation and in situ thrombosis triggered by the chronic consumption of a 'nutritional supplement' which contains synephrine, octopamine, tyramine and caffeine.

Coronary spasm and thrombosis in a bodybuilder using a nutritional supplement containing synephrine, octopamine, tyramine and caffeine.