Is recent cannabis use associated with acute coronary syndromes? An illustrative case series

Abstract

Cannabis is a frequently used recreational drug that potentially imposes serious health problems. We report three cases where recent and/or chronic use of marijuana led to severe cardiac dysfunction. All three patients collapsed at home and required cardiopulmonary resuscitation (CPR) with initial restoration of spontaneous circulation (ROSC). The mechanism of the cardiovascular collapse was different in each case. The first case presented with asystole and was found to have diffuse coronary vasospasm on coronary angiography in the hours after acute cannabis abuse. In the second case, an acute anterior infarction with occlusion of both the right coronary artery (RCA) and the left anterior descendens (LAD) was observed in a young patient without known cardiovascular risks but with chronic cannabis abuse. The third case presented at home with ventricular fibrillation presumably caused by an acute coronary syndrome due to left anterior descending (LAD) artery occlusion. The hetero-anamnesis of the family reported that all three patients had recently used cannabis. Toxicological screening also showed no other substance abuse than cannabis. Using these three cases, we would like to illustrate that the widespread use of cannabis is not as innocent as is believed. Cannabis use can lead to severe cardiovascular problems and sudden death, not only in people at increased cardiovascular risk, but also in young people without any medical history or risk factors.

Prolonged cardiac arrest complicating a massive ST-segment elevation myocardial infarction associated with marijuana consumption

“…In a large cohort of patients with recreational drug overdose-related out-of-hospital cardiac arrests, brain death accounted for more than 30% of fatalities (21). Ventricular fibrillation has been sporadically reported as a result of marijuana consumption (2, 16). A possible explanation for the onset of ventricular dysrhythmias is that cannabis may increase the activity of the Purkinje fibers system (6, 40).…”

“…Although likely under-reported, myocardial ischemia leading to myocardial infarction (MI) has also been described in several reports (9–15). More dramatic features of toxicity have illustrated patients with sudden cardiac death (16–19). Potential mechanisms for sudden cardiac death after marijuana use may be related to the development of acute MI and/or dysrhythmias.…”

Intracoronary thrombus in an 18-year-old teenager. Why?

“…2 The effects of cannabinoids are primarily mediated by the activation of cannabinoid receptors that are present in a variety of tissues including the brain (basal ganglia, pars reticulata of the substantia nigra, entopeduncular nucleus, globus pallidus, putamen, cerebellum, hippocampus, and cerebral cortex) and cells of the immune system, spleen, blood vessels, and the heart. 3 The pharmacological effects of marijuana, based on stimulation of cannabinoid receptors CB1 and CB2 that are widely distributed in the cardiovascular system, have been well described.…”

Causes systémiques ou originales de douleurs thoraciques

“…La métamphétamine donne des tableaux proches [15]. Trois cas d'ischémies cardiaques aiguës du sujet jeune par vaso-spasme ou occlusion coronaire, et ayant été assez graves pour nécessi-ter une réanimation par massage cardiaque, ont été attribués à une consommation récente et importante de cannabis [16]. Chez d'autres toxicomanes (héroïne, ou injections de morphiniques en intraveineux) des fragments d'aiguilles ayant migré jusqu'au coeur ont pu induire des précordialgies d'allure angineuse [17,18].…”