Marijuana and Coronary Dissection: A Case Report and Review of Literature

Abstract

Spontaneous coronary artery dissection (SCAD) is a cardiac emergency and an uncommon cause of acute coronary syndrome (ACS) with a higher predominance in younger women. It is a non-traumatic, non-atherosclerotic lesion found to be associated with pregnancy, inflammatory disorders, connective tissue diseases and substance abuse. Our patient was a young woman with a chronic marijuana smoking history who was found to have a NSTEMI. Initial angiogram showed triple vessel disease involving left anterior descending artery (LAD), left circumflex artery (LCX) and obtuse marginal artery (OM). A repeat angiogram notably showed spontaneous progression with dissection in all three vessels attributable to substance abuse. We present you this rare occurrence of triple vessel SCAD secondary to marijuana with a literature review and discussion.

Efectos adversos del consumo de marihuana en el sistema cardiovascular

“…(Theetha Kariyanna et al, 2021). En un estudio realizado por Auger, N. et al Se demostró que las mujeres con trastornos por consumo de cannabis tuvieron una mayor incidencia de hospitalización cardiovascular que las mujeres no expuestas.…”

In-stent Thrombosis and COVID-19 Infection: Current Insights on the Mechanistic Relationship

“…Diabetes, impaired ventricular function, and advanced age can contribute to stent thrombosis [ 37 , 38 ]. Interestingly, these same factors are associated with more severe presentations of SARS-CoV-2 infection, in which case the propensity for thrombotic complications may be greater.…”

“…In cases of early stent thrombosis, the presence of underlying prothrombotic conditions is of particular importance. In a systematic review of 8 case reports (Table 1 ) of stent thrombosis in patients infected with SARS-CoV-2, it was shown that COVID-19 was likely a major risk factor [ 38 ]. The majority of these cases presented with ST-elevation myocardial infarction (STEMI), a third suffered stent thrombosis on the same day of their PCI, and interestingly 45% developed late stent thrombosis in stents that were implanted over 2 years prior.…”

“…Of particular concern is the high mortality in this group, with 45% of these patients dying during hospitalisation. While most deaths occurred due to stent thrombosis with either failed reperfusion strategies or death prior to any intervention, it is worth mentioning that COVID-19 itself carried high mortality [ 38 ]. However, these findings should be interpreted with caution as they were derived from case reports and case series and therefore do not necessarily prove a causal relationship.…”

“…Interruption of DAPT is a significant contributor to stent thrombosis. Kariyanna et al reported that all patients in their review were on DAPT at the time of developing stent thrombosis [ 38 ]. This poses the question of whether the thrombogenic effect of the disease overwhelms the protective effects of the antiplatelet drugs.…”