Mechanisms for the Risk of Acute Coronary Syndrome and Arrhythmia Associated With Phytogenic and Synthetic Cannabinoid Use

Richards, John R.

doi:10.1177/1074248420935743

Cited by 26 publications

(27 citation statements)

References 146 publications

(188 reference statements)

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“…However, this is not a uniform finding [206]. It seems well established that an increased risk of a cardiovascular event in the wake of cannabinoid use is present even after singular exposure [207][208][209][210]. The increase in tachycardia, which may be a culprit in excessive risk of cardiac events, maybe potentially abolished by pretreatment with clonidine or propranolol, both central sympathomimetics [211,212].…”

Section: Physiological Effect Of Cannabinoids 101 Cardiovascular Effe...mentioning

confidence: 99%

“…Interestingly, cannabinoid concentrations increase in coronary arteries post-acute coronary syndrome, suggesting a beneficial or compensatory effect. This effect may be balanced against the risk of myocardial ischemia, platelet activation, cardiac arrhythmia, and cardiomyopathy [204,208,209,347]. Of note, increased risk of a coronary event is prolonged and occurs after even a single intake of cannabinoid compounds [204].…”

Section: Preoperative Periodmentioning

confidence: 99%

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Considerations for Cannabinoids in Perioperative Care by Anesthesiologists

Laudański

Wain

2022

JCM

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Increased usage of recreational and medically indicated cannabinoid compounds has been an undeniable reality for anesthesiologists in recent years. These compounds’ complicated pharmacology, composition, and biological effects result in challenging issues for anesthesiologists during different phases of perioperative care. Here, we review the existing formulation of cannabinoids and their biological activity to put them into the context of the anesthesia plan execution. Perioperative considerations should include a way to gauge the patient’s intake of cannabinoids, the ability to gain consent properly, and vigilance to the increased risk of pulmonary and airway problems. Intraoperative management in individuals with cannabinoid use is complicated by the effects cannabinoids have on general anesthetics and depth of anesthesia monitoring while simultaneously increasing the potential occurrence of intraoperative hemodynamic instability. Postoperative planning should involve higher vigilance to the risk of postoperative strokes and acute coronary syndromes. However, most of the data are not up to date, rending definite conclusions on the importance of perioperative cannabinoid intake on anesthesia management difficult.

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Section: Physiological Effect Of Cannabinoids 101 Cardiovascular Effe...mentioning

confidence: 99%

Section: Preoperative Periodmentioning

confidence: 99%

Considerations for Cannabinoids in Perioperative Care by Anesthesiologists

Laudański

Wain

2022

JCM

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“…Due to lack of cannabinoids receptors in respiratory epithelial cells of lungs, DNA damage checkpoint mechanism is reported to remain intact even after prolonged cannabis smoking [50]. A pooled analysis of six case-control studies with a total of 2,159 cases and 2,985 controls failed to prove cannabis smoking as a risk factor for lung cancer and reported the overall pooled OR for habitual versus non-habitual cannabis users or never-users 0.96 (95% CI: 0.66-1.38) [51].…”

Section: Cancermentioning

confidence: 99%

"Considerations for the Use of Medical Cannabis: An Overview of Benefits and Harms"

Shakya¹,

Upadhaya

Neupane

et al. 2021

BJSTR

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Cannabis are products of the plants Cannabis Sativa and Cannabis Indica [1]. Cannabis is the most abused illicit drug and is cultivated in 151 nations [2]. Cannabinoids are major pharmacologically active compounds in cannabis which exist mainly as: endocannabinoids, phyto-cannabinoids and synthetic cannabinoids [3]. Endocannabinoids (like anandamide), synthesized by human body, act on cannabinoid receptors (CB): CB1 (brain) and CB2 (immune system) of endocannabinoid system which plays a key role in maintaining body homeostasis. Phyto-cannabinoids are exogenous plant-derived cannabinoids concentrated in oil resin of the buds and the leaves of cannabis plants with affinity for mammalian cannabinoid receptors. Of more than 113 cannabinoids known, tetrahydrocannabinol (THC, a major psychoactive compound) and cannabidiol (CBD, showing therapeutic potential) are major Phyto cannabinoids [4-6]. Synthetic Cannabinoids (like nabilone) are labmade molecules designed to mimic Phyto-cannabinoids action. To date, Food and Drug Administration (FDA) has approved one cannabis-derived drug product (direct plant extract): Epidiolex (cannabidiol) and three synthetic cannabis-related products (synthetic isolates): Marinol (dronabinol), Syndros (dronabinol) and Cesamet (nabilone) [7]. Cannabis use is either 'medical' (treating symptoms/ conditions) or 'recreational' (getting high) [8]. Cannabis is kept under schedule-I (research and medical) drug and is prohibited ARTICLE INFO STRUCTURED ABSTRACTIntroduction: Cannabis use to treat various diseases or symptoms is not clearly defined. The purpose of this review is to explore the existing evidence regarding the harms and benefits of cannabis use across multiple illnesses. Material and Methods:Search for articles for this review was performed in PubMed, Google Scholar and PsycINFO. We summarize and discuss recent evidence regarding cannabis use in multiple neurological (including seizures, neurodegenerative disorders, multiple sclerosis), psychiatric (including depression, bipolar disorder, anxiety and psychotic illness) and other diseases (including chronic pain, cancer, vomiting, cardiovascular diseases, COVID-19). Results:The collated body of evidence shows that the benefit of its use (medicinal or recreational) mostly lacks adequate evidence warranting for further study. In pretext of already available better options (with better efficacy and safety), the consideration of this agent is seriously debatable. Conclusion:Harms or adverse effects of cannabis use clearly are evidence based and are at times serious (e.g. psychosis association), mainly from mental health perspective. Hence, its use should not be suggested and needs serious consideration before using it.

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“…The agonistic action of THC on CB1R causes sympathetic inhibition and increased cardiac vagal tone leading to bradycardia. Acute cannabis smoking of low to moderate doses causes tachycardia in the first 60 minutes from sympathetic stimulation and parasympathetic inhibition, while large and/or chronic doses cause parasympathetic inhibition [16]. The EP effects of intravenous THC in human experimental studies on cardiac conduction include a change in P wave morphology, decrease in sinoatrial (SA) conduction, delay in AH interval, and decrease in AV node refractory period.…”

Section: Slno Patient Characteristics Presentation Management Referencementioning

confidence: 99%

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

Malviya

Khan

Gupta

et al. 2021

Cureus

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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.

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Mechanisms for the Risk of Acute Coronary Syndrome and Arrhythmia Associated With Phytogenic and Synthetic Cannabinoid Use

Cited by 26 publications

References 146 publications

Considerations for Cannabinoids in Perioperative Care by Anesthesiologists

Considerations for Cannabinoids in Perioperative Care by Anesthesiologists

"Considerations for the Use of Medical Cannabis: An Overview of Benefits and Harms"

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

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