Acute myocardial infarction due to marijuana smoking in a young man: guilty should not be underestimated

Velibey, Yalçın; Şahin, Sinan; Tanik, Ozan; Keskin, Muhammed; Bolca, Osman; Eren, Mehmet

doi:10.1016/j.ajem.2015.01.032

Cited by 32 publications

(18 citation statements)

References 16 publications

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“…More recently, it was shown that THC prolongs lipopolysaccharide-stimulated tissue factor protein expression in activated monocytes that results in a dose-dependent procoagulant effect [ 35 ]. This ex vivo observation has been supported by reports of thrombotic coronary artery occlusion in young individuals without underlying atherosclerosis [ 36 – 38 ]. In addition, both CBR1 and CBR2 are present on the cell membrane of human platelets and exposure to THC is shown to increases the surface expression of glycoprotein IIb–IIIa and P selectin in a concentration-dependent manner [ 39 ].…”

Section: Cardiovascular Physiologic Effects Of Cannabinoidssupporting

confidence: 71%

“…In other cases, acute coronary thrombosis in the absence of angiographic atherosclerosis as confirmed by intravascular ultrasonography has been responsible for AMI [ 36 , 37 ]. An extreme case of thrombotic total occlusion of the left main requiring emergent coronary artery bypass graft surgery has also been reported [ 38 ]. The threshold for precipitation of acute myocardial ischemia is likely lower in cannabis users with established atherosclerotic CAD [ 28 , 64 , 65 ].…”

Section: Cardiovascular Complications Of Cannabinoid Usementioning

confidence: 99%

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Cardiovascular Complications of Marijuana and Related Substances: A Review

et al. 2017

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The recreational use of cannabis has sharply increased in recent years in parallel with its legalization and decriminalization in several countries. Commonly, the traditional cannabis has been replaced by potent synthetic cannabinoids and cannabimimetics in various forms. Despite overwhelming public perception of the safety of these substances, an increasing number of serious cardiovascular adverse events have been reported in temporal relation to recreational cannabis use. These have included sudden cardiac death, vascular (coronary, cerebral and peripheral) events, arrhythmias and stress cardiomyopathy among others. Many of the victims of these events are relatively young men with few if any cardiovascular risk factors. However, there are reasons to believe that older individuals and those with risk factors for or established cardiovascular disease are at even higher danger of such events following exposure to cannabis. The pathophysiological basis of these events is not fully understood and likely encompasses a complex interaction between the active ingredients (particularly the major cannabinoid, Δ9-tetrahydrocannabinol), and the endo-cannabinoid system, autonomic nervous system, as well as other receptor and non-receptor mediated pathways. Other complicating factors include opposing physiologic effects of other cannabinoids (predominantly cannabidiol), presence of regulatory proteins that act as metabolizing enzymes, binding molecules, or ligands, as well as functional polymorphisms of target receptors. Tolerance to the effects of cannabis may also develop on repeated exposures at least in part due to receptor downregulation or desensitization. Moreover, effects of cannabis may be enhanced or altered by concomitant use of other illicit drugs or medications used for treatment of established cardiovascular diseases. Regardless of these considerations, it is expected that the current cannabis epidemic would add significantly to the universal burden of cardiovascular diseases.Electronic supplementary materialThe online version of this article (10.1007/s40119-017-0102-x) contains supplementary material, which is available to authorized users.

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Section: Cardiovascular Physiologic Effects Of Cannabinoidssupporting

confidence: 71%

Section: Cardiovascular Complications Of Cannabinoid Usementioning

confidence: 99%

Cardiovascular Complications of Marijuana and Related Substances: A Review

et al. 2017

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“…Additionally, review articles refer to the first hour after cannabis smoking as the riskiest hour, with the risk falling rapidly thereafter . Several authors have reported cases of CVD in proximity to cannabis use, sometimes supported by a positive urinalysis, as reported in Table . However, a positive cannabis finding is common up to 5 days after smoking and, in heavy smokers, positivity may be present for weeks or months .…”

Section: Introductionmentioning

confidence: 99%

Coronary thrombosis and marijuana smoking: a case report and narrative review of the literature

Marchetti

Matteis

et al. 2015

Drug Testing and Analysis

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We encountered evidence of myocardial infarction due to coronary thrombosis in an autopsy of an occasional marijuana smoker. These findings prompted us to perform a narrative review of the literature to determine when post-mortem toxicological tests may support a temporal relationship between marijuana smoking and cardiovascular disease. Toxicological examination showed the presence of Δ-9-tetrahydrocannabinol, its main metabolite and cannabinol in blood and urine. Quali-quantitative analysis revealed that Δ-9-tetrahydrocannabinol was taken within 2 h of the onset of cardiovascular symptoms, according to circumstantial data. Post-mortem toxicological results must take into account the degradation and post-mortem redistribution of analytes. However, for any inference about the specific cardiovascular triggering effect of Δ-9-tetrahydrocannabinol intake, we maintain that cannabinoid analysis in blood samples must be considered an essential requirement to estimate the time of last intake and avoid incomplete documentation. The literature, combined with the present case report, highlights an association between marijuana use and negative cardiovascular events, although few authors have supported their conclusions with toxicological results. Thus, additional research is needed.

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“…Multiple isolated case reports of marijuana associated acute myocardial infarction, including NSTEMI and STEMI, have been previously documented in the literature [16,17,18,19,20]. We present the case of a young male without underlying cardiovascular risk factors with a longstanding heavy marijuana smoking history and recurrent STEMIs with angiographically normal coronary arteries.…”

Section: Discussionmentioning

confidence: 96%

Recurrent STEMI Precipitated by Marijuana Use: Case Report and Literature Review

Wengrofsky

Mubarak

Shim

et al. 2018

AJMCR

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Marijuana abuse is rapidly growing and currently it is the most coimnon drug of abuse in the United States due to increased legalization for recreational and medicinal use. Delta 9-tetrahydrocannibol, the main psychoactive compound in marijuana, acts via the endocannabinoid system to elicit various cardiovascular physiological effects, and has been associated with many adverse cardiovascular effects such as acute coronary syndrome, arrhythmias, and sudden cardiac death that have previously been reported by our group and others. We present a case of a 30-year-old African-American male with no cardiovascular disease (CVD) risk factors with recurrent ST-segment elevation myocardial infarctions (STEMI) whose coronary angiography revealed recurrent 100% occlusion of the left anterior descending artery (LAD) in the setting of marijuana smoking. It was the patient’s third STEMI with 100% occlusion of the LAD with each STEMI secondary to thrombosis of a different region of the LAD. Marijuana use was confirmed by urine toxicology screening at each STEMI presentation. Coronary angiography on multiple occasions was negative for stenosis of other epicardial coronary arteries, and coronary calcimn scoring was zero. Evaluation for other cardiovascular risk factors including family history of premature coronary artery disease, dyslipidemia, diabetes, and hypercoagulable disorders was negative. Further studies are required to elucidate the mechanisms of marijuana-associated coronary thrombosis and myocardial infarction.

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Acute myocardial infarction due to marijuana smoking in a young man: guilty should not be underestimated

Cited by 32 publications

References 16 publications

Cardiovascular Complications of Marijuana and Related Substances: A Review

Cardiovascular Complications of Marijuana and Related Substances: A Review

Coronary thrombosis and marijuana smoking: a case report and narrative review of the literature

Recurrent STEMI Precipitated by Marijuana Use: Case Report and Literature Review

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