Marijuana Induced Coronary Vasospasm

Abstract

Marijuana has become one of the most commonly used recreational drug. Much of its use, is based upon its belief that it is relatively "safe" especially when compared to other drugs. This case, among others, highlights the fact that although marijuana has been utilized for many years in many cultures for many medical reasons, it does not come without risk. Specifically, we like to focus on cardiovascular risk associated with marijuana use. Relatively speaking, extensive research has not been done to localize marijuana and the specific mechanisms by which it can cause cardiovascular morbidity and mortality. However, it is also not an undocumented phenomenon. There have been varieties of case reports as well as studies, which have studied the cardiovascular toxicity, which are associated with marijuana use. Such toxicities include that of Acute Myocardial Infarction (AMI), vasospasm, LV thrombus among others. Here we present one such presentation of a patient with coronary vasospasm presenting as NSTEMI soon after heavy marijuana use.

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

“…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].…”

Considerations for Cannabinoids in Perioperative Care by Anesthesiologists

“…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].…”

“…Acute coronary syndrome is limited to case reports and linked to increased platelet activation and autonomic instability [126,196,207,292]. Interestingly, endogenous cannabinoids are at an increased concentration in hypoperfusion syndrome and serve as coronary dilators [347]. The effect of cannabinoids on the pulmonary system seems to be limited to potential irritation, inflammation, and immune suppression [90][91][92]170,215,219,224].…”

Clinical Considerations for Cannabis Use and Cardiovascular Health

“…Understanding these delayed cardiovascular responses is especially critical in patients with underlying cardio-vascular comorbidities and those who have a higher risk of stroke. Chronic cannabis use has been associated with oxidative endothelial injury, atherosclerotic changes, dysrhythmias, coronary vasospasm, and cerebral hypoperfusion [36][37][38][39][40][41]. All these described effects can potentially be pathophysiological mechanisms for MACE linked to cannabis use (Fig.…”