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

Abstract

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.

Role of Cannabis in the Incidence of Myocardial Infarction: A Review

“…There was an elevation of ST-segment in electrocardiogram (EKG) leads II, III, and aVF and ST-segment depression in leads of aVL, V4, and V5. They diagnosed it as ST-segment Elevation Myocardial Infarction (STEMI)[31]. Yurtdaş et al reported a case of a 26-year-old male who came to their clinic with complaints of radiating chest pain to both his upper limbs.…”