Can energy drinks (EDs) cause heart problems, such as tachycardia or hypotension, and what are the recommendations for safe consumption?

Energy Drinks and Heart Problems

Energy drinks with high concentrations of caffeine and taurine increase blood pressure and can lead to acute or chronic cardiovascular complications, particularly in young adults, and should be strongly discouraged. 1

Cardiovascular Risks Documented

Energy drinks pose multiple serious cardiac threats:

Acute Cardiovascular Events

• Myocardial infarction can occur even in young, previously healthy individuals without traditional cardiovascular risk factors—a 28-year-old man developed complete thrombotic occlusion of his LAD artery requiring stenting just 4 hours after consuming 5 cans of energy drink 2
• Sudden cardiac arrest has been documented in 5% of survivors who consumed energy drinks temporally related to their event, particularly in those with underlying genetic heart conditions like long QT syndrome and catecholaminergic polymorphic ventricular tachycardia 3
• Cardiac arrhythmias, prolonged QT interval, aortic dissection, and death have all been reported in association with energy drink consumption 4

Blood Pressure Effects

• Systolic blood pressure increases by up to 5.23 mmHg and diastolic by up to 3.29 mmHg acutely after energy drink consumption in children and adolescents 5
• The prevalence of elevated blood pressure, stage 1 hypertension, and stage 2 hypertension is significantly higher after energy drink consumption compared to placebo 5
• These effects are particularly concerning because they occur even in healthy individuals without pre-existing cardiovascular disease 5

Mechanism of Harm

• Energy drinks create a hypercoagulable state through detrimental effects on platelet and endothelial function, increasing thrombosis risk 2
• The combination of caffeine, taurine, guarana, and other stimulants alters heart rate, blood pressure, cardiac contractility, and cardiac repolarization in a potentially proarrhythmic manner 3

Specific Populations at Highest Risk

Children and Adolescents

• Minors should be strongly discouraged from drinking energy drinks, particularly those with any pre-existing health conditions 5
• Sugar-sweetened beverages (which include energy drinks) increase systolic blood pressure and the risk for incident hypertension in this age group 1

Young Adults

• Young adults are specifically identified as being at risk for acute and chronic cardiovascular complications from energy drinks 1
• Even those without apparent cardiovascular risk factors can experience life-threatening events 2

Patients with Genetic Heart Conditions

• Those with long QT syndrome, catecholaminergic polymorphic ventricular tachycardia, or idiopathic ventricular fibrillation are at particularly high risk for sudden cardiac arrest when consuming energy drinks 3
• All sudden cardiac arrest survivors in one series who quit consuming energy drinks remained event-free thereafter 3

Recommendations for Safe Consumption

There is no safe level of energy drink consumption that can be recommended based on current evidence. The most prudent approach is complete avoidance, particularly for:

• Children and adolescents of any age 5
• Individuals with any known cardiac condition, especially genetic arrhythmia syndromes 3
• Patients with hypertension or at risk for hypertension 1
• Anyone with a family history of sudden cardiac death 3

Alternative Beverages

• Sugar-sweetened beverages in general (including sports drinks and energy drinks) should be discouraged due to their association with increased cardiovascular disease risk 1
• Free sugar consumption should be restricted to a maximum of 10% of energy intake 1
• Regular coffee consumption (up to 3 cups/day) is not associated with higher hypertension risk and may actually be associated with lower risk for incident hypertension, making it a safer alternative for those seeking caffeine 1

Common Pitfalls to Avoid

• Do not assume "moderate" consumption is safe—even single episodes of energy drink consumption have triggered myocardial infarction and sudden cardiac arrest 2, 3
• Do not dismiss chest pain in young patients who consume energy drinks—maintain a high index of suspicion for acute coronary syndrome 2
• Do not overlook the cumulative effect of ingredients—energy drinks contain multiple stimulants beyond caffeine (taurine, guarana, L-carnitine) whose interactions are poorly understood 6
• Do not fail to screen for regular consumption—43% of sudden cardiac arrest survivors in one series were regular energy drink consumers 3

Clinical Approach When Energy Drink Consumption is Suspected

When evaluating patients with cardiovascular symptoms who may have consumed energy drinks:

• Obtain detailed history of energy drink consumption including brand, quantity, and temporal relationship to symptoms 2, 3
• Perform ECG looking specifically for arrhythmias, QT prolongation, and ST-segment changes 2, 3
• Consider echocardiography if myocardial infarction is suspected 2
• Screen for underlying genetic cardiac conditions, particularly in young patients with unexplained arrhythmias or sudden cardiac arrest 3
• Counsel all patients, especially those with any cardiac event, to permanently discontinue energy drink consumption 3