Marijuana-induced Coronary Vasospasm with Persistent Inter-coronary Connection: A Case Report and Review of Literature

Baskaran, Janani; Narayanan, Mahesh Anantha; Vakhshoorzadeh, Jasmine; Ahmad, Aiza; Bertog, Stefan

doi:10.7759/cureus.4799

Cited by 5 publications

(3 citation statements)

References 18 publications

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“…Although few case reports in the past have described coronary vasospasm, with this case report, we have tried to describe one of the rare cases of coronary vasospasm with significant troponin elevation in the setting of transient EKG changes [13]. In another case report, a patient with cannabinoid hyperemesis syndrome was reported to have STEMI with coronary vasospasm, without any troponin elevation, and Echo findings consistent with Takotsubu cardiomyopathy [14].…”

Section: Discussionmentioning

confidence: 97%

Coronary Vasospasm Associated With Synthetic Marijuana Resulting in Transient Electrocardiogram Changes and Troponin Elevation

Fatmi¹,

Outlaw²

2022

Cureus

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Chest pain is a common presentation in the emergency department requiring prompt evaluation and risk stratification to assess for acute coronary syndrome versus non-cardiac causes. In the past, cocaine has been documented to be associated with the presentation of acute myocardial infarction. This case report describes a rare case of coronary vasospasm with transient electrocardiogram (EKG) changes and significantly elevated troponin in an individual presenting with a recent history of synthetic marijuana use. This report highlights the initial presentation, progression, and management of synthetic marijuana-associated coronary vasospasm mimicking the presentation of acute myocardial infarction. This is a unique case that describes not only the clinical presentation with dynamic EKG changes but also significantly elevated biomarkers, as would be seen with acute myocardial infarction. Challenges associated with synthetic marijuana-mediated coronary vasospasm are not only related to the management but also present a diagnostic challenge because it is not easily detected by urinary drug screen compared to traditional marijuana.

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Section: Discussionmentioning

confidence: 97%

Coronary Vasospasm Associated With Synthetic Marijuana Resulting in Transient Electrocardiogram Changes and Troponin Elevation

Fatmi¹,

Outlaw²

2022

Cureus

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“…46,47 Finally, we also found that a higher percentage of patients with cannabis usage required mechanical thrombectomy (1.8%, compared with 1.6%), and presented with a higher risk of mortality (aOR: 5.169). As the consumption of cannabis can cause several cardiac arrhythmias, [44][45][46] vasospasms, 48 imbalances in coagulation, 7,49,50 protocols to monitor various possible side effects in such patients should be adopted. Furthermore, our study was unable to determine the outcomes of these patients' thrombectomy based on the centres' volumes, "doorto-groin" time, and the physicians' experience, which may have impacted the prognosis of these patients.…”

Section: Discussionmentioning

confidence: 99%

Acute Ischemic Stroke Among Cannabis Users in the United States and Possible Risk Factors for Mortality

et al. 2022

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Background: With changes in state laws, cannabis is now more accessible in many parts of the United States. The drug has previously been associated with a higher incidence of acute ischemic stroke (AIS). Our study analyzed the effect of cannabis use on AIS outcomes. Methods: The 2019 National Inpatient Sample from Healthcare Cost and Utilization Project and Agency for Healthcare Research and Quality was used to evaluate the AIS patients ages 25 and more. Cannabis users were compared with nonusers. Their mortality risks were also assessed. Results: Five hundred thirty-nine thousand eight hundred eighty patients with AIS were in our study and 8850 used cannabis. Among the cannabis users with AIS, 69.8% were males, 50.6% were white, 61.8% were aged 46 to 65, 32.1% used Medicaid, 86.1% were nonobese, 72.0% were nondiabetics, 81.7% had hypertension, 80.7% did not have a history of alcohol abuse, and 77.5% were smokers (nicotine). Only 12.8% of cannabis users reported any cardiac dysrhythmia, whereas 5.4% required mechanical thrombectomy, and 8.0% received intravenous tissue plasminogen activator (tPA). After adjusting the variables, cannabis users covered by Medicare, with diabetes, a history of alcohol abuse, cardiac dysrhythmias, and who underwent mechanical thrombectomy had a higher risk of dying. The overall adjusted odds ratio of dying among cannabis users with AIS was 0.603 (95% CI, 0.504-0.722, P<0.01). Conclusions: Although the overall mortality risk seems to be lower among cannabis users, those with certain risk factors still present higher mortality risks. Patients with cannabis use should therefore be monitored closely for possible complications and mortality after AIS.

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“…Marijuana is known to cause vascular endothelial dysfunction [19]. Multiple similar cases of STEMI [20,21,22,23] and NSTEMI related to marijuana induced have been reported in the past [24].…”

Section: Discussionmentioning

confidence: 99%

Marijuana-induced Coronary Vasospasm and Myocardial Infarction: A Case Report and Review of Literature

Kariyanna

Chandrakumar

Feit

et al. 2020

AJMCR

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The usage of marijuana and its legalization has been growing rapidly, being abused by a wide range of age groups. Its effects on the heart are well known, but coronary artery vasospasm causing ST elevation myocardial infarction (STEMI) from Marijuana alone is rather lesser known. Herein, we report a case of a middle aged African American man with a significant tobacco smoking history who presented with chest pain typical of myocardial infarction (MI) soon after smoking marijuana. ECG showed ST elevation in inferior leads with first degree AV block and a urine drug screen positive only for marijuana. Coronary angiogram showed mid right coronary artery (RCA) obstruction which was relieved upon injection of intracoronary nitroglycerine. This case report reinstates the significance of considering substance abuse as an etiology of STEMI during initial presentation, ruling out with urine drug samples. We also present a literature review of coronary vasospasm with STEMI, induced specifically by Marijuana and its pathophysiologic mechanisms.

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Marijuana-induced Coronary Vasospasm with Persistent Inter-coronary Connection: A Case Report and Review of Literature

Cited by 5 publications

References 18 publications

Coronary Vasospasm Associated With Synthetic Marijuana Resulting in Transient Electrocardiogram Changes and Troponin Elevation

Coronary Vasospasm Associated With Synthetic Marijuana Resulting in Transient Electrocardiogram Changes and Troponin Elevation

Acute Ischemic Stroke Among Cannabis Users in the United States and Possible Risk Factors for Mortality

Marijuana-induced Coronary Vasospasm and Myocardial Infarction: A Case Report and Review of Literature

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