Acute myocardial infarction temporally related to betel nut chewing

A patient with coronary artery disease suffered an acute myocardial infarction temporally related to chewing a betel nut. Alkaloids in betel nut, such as arecoline, may play a contributing role in coronary artery spasm due to parasympathomimetic effects on vessels with abnormal endothelium. Chewing betel nuts may instantly induce a high concentration of arecoline in the circulation and do harm to a chewer with a history of coronary artery disease.