Vaping Induced Cardiac Complications - A Smokescreen Coming to Engulf the Heart?

Abstract

E-cigarette usage has been shown to be associated with lung injury. However, there has been limited data of cardiovascular complications in e-cigarette users. We present two patients that developed cardiac complications after recent increased e-cigarette usage-the first with non-ischemic cardiomyopathy after a month of electronic cigarette usage at the highest power setting of 40 Watts, and the second with predominantly non-ischemic cardiomyopathy with underlying single vessel coronary artery disease after a threefold increase in e-cigarette usage for the preceding three months. In addition, to the best of our knowledge, this is the first report of an association between e-cigarette usage and heart failure.

Acute myocardial infarction with e‐cigarette or vaping‐use associated lung injury in a young Filipino vape user

“…3 Aside from the current standards of care in management of acute myocardial infarction and the discontinuation of e-cigarette use, no additional recommendations have been made regarding the treatment of vape-use associated myocardial injury. 1,6,7 This case report is the first in the Philippines that links vape use to the development of both acute lung injury and myocardial infarction. The limitation of this study includes the lack of vape liquid analysis for further biochemical study and its qualitative nature.…”

“…6 In regards to cardiovascular events, a meta-analysis by Ashraf et al in 2023 analysed data from the National Health Interview Surveys and noted an increased risk for acute myocardial injury among e-cigarette users with an odds ratio of 1.44. 1 Non-ischemic cardiomyopathy and two vessel coronary artery disease attributed to vape use has been documented in a case series by Benji et al 7 Simultaneous occurrence of both EVALI and vape-induced cardiomyopathy has also been reported in some case studies but only the study of Abusharekh et al has documented concomitant small to medium vessel coronary artery disease and EVALI. [3][4][5] Particulates, acrolein and oxidizing chemicals in the inhaled aerosols have been proposed to cause atherosclerosis by (1) inducing airway irritation leading to vagal nerve activation, consequent flow mediated dilation impairment and endothelial dysfunction, and (2) triggering systemic inflammation leading to platelet activation, thrombosis and also endothelial dysfunction.…”

“… 6 In regards to cardiovascular events, a meta‐analysis by Ashraf et al in 2023 analysed data from the National Health Interview Surveys and noted an increased risk for acute myocardial injury among e‐cigarette users with an odds ratio of 1.44. 1 Non‐ischemic cardiomyopathy and two vessel coronary artery disease attributed to vape use has been documented in a case series by Benji et al 7 Simultaneous occurrence of both EVALI and vape‐induced cardiomyopathy has also been reported in some case studies but only the study of Abusharekh et al has documented concomitant small to medium vessel coronary artery disease and EVALI. 3 , 4 , 5 …”

“…The use of glucocorticoids is common practice in patients diagnosed with EVALI but is actually only recommended for patients who develop worsening symptoms or clinical deterioration 3 . Aside from the current standards of care in management of acute myocardial infarction and the discontinuation of e‐cigarette use, no additional recommendations have been made regarding the treatment of vape‐use associated myocardial injury 1,6,7 …”

“… 3 Aside from the current standards of care in management of acute myocardial infarction and the discontinuation of e‐cigarette use, no additional recommendations have been made regarding the treatment of vape‐use associated myocardial injury. 1 , 6 , 7 …”