# Chocolate-Induced Sinus Tachycardia: A Sweet Surprise

## TL;DR

A man's sinus tachycardia was linked to high chocolate consumption, showing dietary factors can cause heart rate issues.

## Contribution

This case report identifies chocolate as a potential trigger for sinus tachycardia, emphasizing dietary evaluation in unexplained tachycardia.

## Key findings

- Excessive chocolate intake was linked to sinus tachycardia in a 63-year-old male.
- Symptoms resolved with bisoprolol, fluids, and dietary changes.
- Chocolate's methylxanthines can increase heart rate and blood pressure.

## Abstract

Sinus tachycardia is a common clinical presentation caused by various physiological or pathological factors and triggers. Determining the underlying cause of this presentation is crucial for providing effective and appropriate management.

We report the case of a 63-year-old male who presented to the emergency department with palpitations and dizziness. He had no associated symptoms such as chest pain, syncope, or breathlessness. Electrocardiography showed sinus tachycardia without any additional abnormalities. Laboratory investigations, including inflammatory markers, thyroid function tests, and cardiac enzymes such as d-dimer and troponin, were within normal limits. Additionally, a detailed history revealed excessive chocolate consumption of approximately 180 grams nightly for two weeks. He was treated with bisoprolol, intravenous fluids, and dietary counselling, which led to the resolution of his symptoms.

Chocolate contains methylxanthines, such as caffeine and related stimulants, which can increase heart rate and blood pressure, and may induce arrhythmias by stimulating the sympathetic nervous system. These effects can occur even in individuals without pre-existing cardiovascular disease. Consequently, dietary factors should not be overlooked during the evaluation of unexplained tachycardia, as they may play a significant role in its aetiology.

This case highlights the importance of considering dietary factors, like chocolate and caffeine intake, when assessing patients with tachycardia. Identifying reversible, lifestyle-related causes can prevent unnecessary investigations and ensure the initiation of effective management.