Chronic Marijuana Consumption Leading to High-Grade Atrioventricular Block in a Young Male

Abstract

Cannabis usage is increasing throughout the world for both medicinal and recreational purposes. Several countries and states have legalized cannabis, and physicians can expect to encounter more patients who use or abuse cannabis. Adverse cardiovascular effects of cannabis like myocardial infarction, cardiomyopathy, and arrhythmias have been well described but bradyarrhythmia is rare and the mechanisms are not well pronounced. A 26-year-old male with a history of chronic cannabis smoking presented with complaints of dizziness and recurrent syncope. The heart rate at presentation was 42 beats per minute and the rest of the physical examination was unremarkable. There was an atrioventricular (AV) block in the ECG and a subsequent electrophysiological study (EPS) showed a high-grade supra-Hisian (nodal) AV block with prolonged His-ventricular (HV) interval. The urinary screen was positive for tetrahydrocannabinol metabolite (11-Nor-9-carboxy THC). After ruling out other possible causes, a diagnosis of high-grade AV block due to chronic cannabis use was made. A dual-chamber pacemaker was implanted and the patient was discharged in stable condition. The arrhythmia did not improve completely at the three-month follow-up. We report a novel finding in cannabis-induced bradyarrhythmia. High-grade AV block with the electrophysiologic determination of the site of conduction blockade has not been reported previously. The mechanism of bradyarrhythmia is thought to be mediated by increased vagal tone. However, prolonged HV interval and persistent nature of block indicate that direct toxic effects of cannabis, through cannabinoid receptors 1 (CB1R), on the cardiac conduction system cannot be ruled out. Also, the possibility of cannabis arteritis involving microvasculature should be kept.

Serum Proteomic Analysis of Cannabis Use Disorder in Male Patients

“…Studies have documented toxicological effects in different models exposed to cannabis ingredients [ 12 , 13 , 14 , 15 , 16 ]. A recent study reported that high-grade atrioventricular block was developed in a young male following chronic exposure to marijuana [ 14 ].…”

“…Studies have documented toxicological effects in different models exposed to cannabis ingredients [ 12 , 13 , 14 , 15 , 16 ]. A recent study reported that high-grade atrioventricular block was developed in a young male following chronic exposure to marijuana [ 14 ]. Moreover, a recent case series study concluded that vaping cannabis oil was associated with acute respiratory depression [ 15 ].…”

Širdies Aritmijos Ir Kanapių Vartojimas

“…Dėl adrenerginės stimuliacijos sutrumpėja kardiomiocitų veikimo potencialo trukmė bei pakinta miokardo elektrofiziologinės savybės, sudarančios palankias sąlygas padidėjusio automatizmo bei micro-reentry aritmijų patogenezei, ypač jei asmuo turi polinkį į tachiaritmijas [1, 27,28]. Didesnės kanapių dozės stimuliuoja parasimpatinę ANS, ilgėja veikimo potencialo ir prieširdžių refrakterinis periodas, galimos macro-reentry aritmijos, įvairios bradiaritmijos, silpno sinusinio mazgo sindromas (SSMS), pauzės su sinkopėmis, AV blokados [1, 15,[29][30][31][32]. Aritmijų patogenezėje svarbi ir kanapių vartojimo sąlygota miokardo išemija, padidėjęs deguonies poreikis, trombocitų aktyvacija [1,20,[33][34][35].…”

“…KVS pacientų su aritmija grupėje 7,8% patyrė PP, 7,5% SkT, 4,4% SVT 4,4%, 3,7% SkV 3,7%, 2,5% SSMS, 1,6 % trečio laipsnio AV mazgo blokadą [13]. Aritmijos kanapių vartotojams gali pasireikšti sinkopėmis, širdies plakimu, sąmonės sutrikimu, krūtinės skausmu, bendru silpnumu [15,25,[29][30][31][32][34][35][36]. Aprašyti su kanapių ar kanabinoidų vartojimu susijusių aritmijų atvejai, kai išsivystė gyvybei pavojingos skilvelinės aritmijos, kardiogeninis šokas, staigi mirtis arba laidumo sutrikimai, kai buvo reikalinga širdies stimuliatoriaus implantacija [6,15,25,30,32].…”

Efectos adversos del consumo de marihuana en el sistema cardiovascular

“…Además, el uso crónico de THC se ha asociado con una mayor frecuencia de angina, probablemente debido a una disminución en el umbral anginoso, disminución de la transducción de señales del sistema nervioso simpático y parasimpático, aumento de la aldosterona sérica, vasoconstricción central y periférica e hipertensión (HTN). (Malviya et al, 2021;Subramaniam et al, n.d.;Yeniocak et al, 2021) METODOLOGÍA Se realizó una investigación con enfoque cuantitativo no experimental de tipo descriptivo y retrospectivo, mediante una búsqueda exhaustiva en diferentes bases de datos que incluyen: Google Scholar, PubMed, Embase y Elsevier en la literatura de habla inglesa, y Latindex, Scielo, y Google Scholar en la literatura de habla española. Se utilizaron como términos y/o palabras claves de búsqueda: efectos cardiovasculares del consumo de marihuana, patologías asociadas con el consumo de marihuana, marihuana e infarto de miocardio, marihuana e hipertensión.…”