Cold Drink Heart

By: Joseph Taiwo | Tags: | Comments: 0 | August 18th, 2020

There is a 40 year old construction worker who has been working in the intense heat West Texas , Temp was 103. Mid day he was already hot and exhausted  he was very desperate for a cold drink , so on his way home he stopped at a  convenience Sonic store  to purchase a frozen Slushie .

He  was very grateful for the cool drink relief ,until the piercing headache struck . The Brain freeze  was painful  but soon resolved , after the resolution fo the brain freeze he developed some irregular hear beat with palpitations.  He attempted to remain calm  and practice deep  breathing , but the palpation persisted so he decided to got to the nearest  Emergency Department . At the ER he was placed on a monitor , and the monitor revealed that he was in paroxysmal atrial fibrillation . His heart was completely out of rhythm , patient was subsequently ,  cardioverted pharmacologically and then sent homme with strict warning to avoid caffein .

What is the effect of caffein?

Caffeinated coffee and tea are the most consumed, socially accepted stimulants in the world. Approximately 90 percent of all adults in the world consume caffeine daily. In their natural forms, coffee and tea contain several chemical components that may confer both beneficial and adverse health effects, including caffeine and antioxidants (eg, polyphenols, catechins, and flavonoids).

Most of the data on the health benefits and risks of caffeine are from observational studies in which self-reported consumption of beverages and foods is associated with health outcomes. Such studies make it difficult to identify caffeine itself as the causative agent and to exclude residual confounding. Based on available data, there is insufficient evidence for promoting or discouraging regular coffee and/or tea consumption. Caffeine has multiple systemic effects on the neuropsychiatric, cardiovascular, endocrine, and gastrointestinal systems. The impact on health may be modified by genetic factors, age, sex, medications, and other environmental exposures.

Specific Health Effect of Caffein’

• Caffeine has been shown to influence cognition and mood, both acutely and chronically. Its effects, however, vary depending on the study population and the amount and duration of caffeine consumed. In rested individuals, caffeine in low and moderate doses, approximately 30 to 300 mg, improves vigilance and reaction time .In sleep-deprived individuals, caffeine’s positive effects generalize to a wide variety of functions, including learning and decision-making and real-world activities such as automobile and aircraft operation. Individuals who are habitual consumers of coffee and tea perform better on various tests of cognitive performance, such as reaction time and visuospatial reasoning 
• Caffeine consumption leads to increased alertness, mental energy, and ability to concentrate, particularly when subjects are fatigued or working at night . This is probably the fundamental reason why so many humans regularly consume caffeine. Caffeine mitigates the adverse effects of sleep deprivation on a wide variety of cognitive functions. A systematic review of 13 randomized trials of persons with jet lag or shift work disorder found that caffeine significantly improved concept formation, reasoning, memory, orientation, attention, and perception when compared with placebo.
• Caffeine has significant pharmacologic properties that can alleviate or generate headache symptoms. Caffeine has long been used for its analgesic properties in the treatment of headache and is frequently used alone or in combination with other medications. Randomized trials have found that combination medications that include caffein are more effective for tension and migraine headaches than acetaminophen or low-dose alone.
• The relationship between coffee or tea and the risk of Parkinson disease has been described in several studies . A meta-analysis found evidence of a dose-response relationship between coffee or tea intake and decreased risk for Parkinson disease [52]. The mechanism of how caffeine might protect against Parkinson disease is not known.
•  There are very few studies examining the relationship between coffee and Alzheimer disease. In a pooled analysis of two cohort and two case control studies on coffee and Alzheimer disease, coffee consumption was associated with a small protective effect against Alzheimer disease . These findings are supported by data from Alzheimer transgenic mice in which supplementation with caffeine was associated with lower or delayed risk of Alzheimer disease
• Low to moderate coffee consumption (up to three cups per day) may protect against myocardial infarction. Heavy coffee intake may trigger coronary and arrhythmic events in susceptible individuals, although coffee intake is not considered a long-term risk factor for myocardial disease. The association between coffee and cardiovascular disease is discussed in detail separately
• Low to moderate coffee consumption (up to three cups per day) may protect against myocardial infarction. Heavy coffee intake may trigger coronary and arrhythmic events in susceptible individuals, although coffee intake is not considered a long-term risk factor for myocardial disease. The association between coffee and cardiovascular disease is discussed in detail separately
• Caffeine consumption is associated with a reduced risk of diabetes, although causality has not been established. 
• The evidence for the effects of caffeine consumption on glucose metabolism is mixed. Although short-term studies have shown that the acute administration of caffeine can induce insulin resistance and impaired glucose tolerance .several prospective long-term studies have shown that consumption of coffee or tea is associated with improved insulin sensitivity and better control of postprandial glycemia in patients with diabetes
• Caffeine is a potent stimulator of smooth muscles and thus might have an impact on bowel function. In an observational study of 1705 women, coffee consumption was associated with a modest decrease in constipation. In the same study, however, consumption of Chinese and Japanese tea was associated with an increased incidence of constipation, suggesting that other components in the tea mitigated the effect of caffeine on smooth muscle stimulation.
•  Coffee consumption has been associated with a decreased risk for cirrhosis. In a meta-analysis including 16 observational studies, compared with nondrinkers, coffee drinkers were less likely to develop cirrhosis

Other effect of caffein are :

Arrythmia

Despite the theoretical relationship between caffeine and arrhythmogenesis, the available clinical evidence suggests that caffeine in doses typically consumed (ie, up to about 400 mg per day, which is roughly equivalent to up to five cups of coffee) does not provoke arrhythmias .

Nevertheless, there are patients who may be more sensitive to caffeine and note a relationship of palpitations to caffeine intake.

In addition, there are case reports of arrhythmia in patients with underlying cardiac disease who have ingested excessive amounts of caffeine. Thus, patients susceptible to cardiac arrhythmias should avoid consuming large quantities of caffeine, although modest amounts appear to be safe.

Heart Rate Variability

 Heart rate variability has been examined in a number of studies among habitual consumers of caffeine or coffee. In a systematic review of 12 trials that evaluated the effect of 400 to 500 mg caffeine per day, there was not a consistent relationship with heart rate variability; however, the evidence as a whole supports the notion that 400 mg caffeine per day in healthy adults is not associated with an increases in heart rate variability .

Blood Pressure

Caffeine can acutely raise the blood pressure (BP) by as much as 10 mmHg in individuals who are infrequently exposed , but there is little or no acute effect on BP in habitual coffee drinkers.

With regard to its impact in non-habitual coffee drinkers, caffeine can potentiate (by about 5 to 10 mmHg) a rise in BP induced by stress, such as that occurring in the workplace. The acute elevation BP caused by caffeine is more pronounced in hypertensive patients; compared with subjects with optimal blood pressure, those with hypertension had a >1.5-fold greater increase in blood pressure . The hypertensive effect may be more prominent in older adult patients with hypertension

Diuretic Effect

Caffeine and related methylxanthine compounds in higher doses may have a diuretic action. One literature review suggested that acute ingestion of caffeine in doses of at least 250 to 300 mg, equivalent to amounts found in two to three cups of coffee or five to eight cups of tea, results in short-term stimulation of urine output in individuals deprived of caffeine for a period of days or weeks . A tolerance to the diuretic effect develops and diureses is diminished in those who regularly consume tea or coffee. Doses of caffeine equivalent to amounts found in standard servings of tea, coffee, and carbonated soft drinks appear to have little diuretic action.

Aortic Stenosis

Aortic stiffness is an important determinant of the performance of the cardiovascular system and prognosis of cardiovascular risk. Caffeine acutely increases arterial stiffness, and the effect is synergistic with smoking. The ingestion of 200 mg of caffeine (equivalent to two cups of coffee) increased pulse-wave velocity and augmentation index by 0.33 m/s and 4 percent, respectively, an effect that was augmented when combined with smoking (increased by 0.85 m/s and 17.4 percent, respectively)

Lipid

The evidence presented below suggests no major impact of filtered coffee consumption on the lipid profile. Thus, we do not recommend discontinuation of coffee consumption to improve the lipid profile. Most studies have shown no adverse effects of filtered coffee intake on plasma lipids

Misleading Instructions

The patent was given instruction to avoid caffein, he found  the advice strange because his two cups of coffee morning routine was unchanged and  seemed unrelated . He knew the slushie had provoked the brain freeze ;why not also the concurrent Atrial Fibrillation ? The doctor was steadfast , however he had been taught of jittering caffeine heart, but had never heard of cold drink heart .

The Patient disregards the physician advice  and continued his morning  coffee but steered  clear of any cold drinks triggers .{ Non compliance is not always foolish}

Patient went three years without any  symptomatic  AF until he returned to that same store for a Groundhog Day experience ,which landed him back in the same Emergency department

For this patient he later realized that the ingestion of cold drinks and food is a trigger  for their paroxysmal AF . When  we say cold drink we mean non alcoholic drink .

As well as alcohol binging can cause arrythmia , also cold drink sludge.

If the cause of the palpitation is as a result of cold drink ,smoothie or frozen yogurt, the diagnosis is  Cold Drink Heart . The treatment is to avoid cold drink slush or cold drink smoothie

Dr Joseph Taiwo