Myocardial Infarction Secondary to Marijuana-Induced Coronary Vasospasm

Abstract

With the rise of the number of states fully legalizing marijuana, the use of this substance in the United States is at an all-time high. This increasing legalization gives the impression that marijuana is rather safe. However, multiple reports by our groups and others documented serious cardiovascular complications associated with marijuana use ranging from life threatening arrhythmia to myocarditis and myocardial infarction. In this report, we present a case of a 61 year old man presented with left sided typical chest pain shortly after marijuana consumption with the diagnosis of non ST-elevation myocardial infarction (NSTEMI) established based on clinical, EKG and troponin values with eventual cardiac catheterization documenting non-occlusive coronary artery disease with 30% obstruction of the proximal first obtuse marginal artery. We also review the putative pathophysiologic mechanisms of marijuana induced coronary vasospasms, highlighting the implications of these findings in the evaluation and management of cardiac chest pain in marijuana users.

Cannabis Use Disorder Trends and Health Care Utilization After Cervical and Lumbar Spine Fusions

“…11,34,36 Furthermore, cannabis has been shown to induce a prothrombotic state that leads to a higher risk of myocardial infarction and stroke. [37][38][39] The present study demonstrated an increase in MI at six and 12 months postoperatively in the setting of CUD for the lumbar fusion cohort and an increase of stroke or other neurological injury at index hospitalization and in the six and 12 months postoperative time frame for those with CUD in the cervical cohort or subgroups with myelopathy and radiculopathy. In a recent retrospective cohort analysis using the 2012 to 2015 Nationwide Inpatient Sample, Chiu et al 6 found that cannabis abuse in cervical fusion was associated with increased index hospitalization morbidity in thromboembolism (1.9% vs. 0.9%) and neurological complications such as stroke and anoxic brain injury (1.1% vs. 0.3%).…”

“…Hemodynamic variations that predispose to plaque rupture and demand ischemia may result along with heightened blood pressure even after low doses that can last up to three hours after use 11,34,36 . Furthermore, cannabis has been shown to induce a prothrombotic state that leads to a higher risk of myocardial infarction and stroke 37–39 . The present study demonstrated an increase in MI at six and 12 months postoperatively in the setting of CUD for the lumbar fusion cohort and an increase of stroke or other neurological injury at index hospitalization and in the six and 12 months postoperative time frame for those with CUD in the cervical cohort or subgroups with myelopathy and radiculopathy.…”

Paroxysmal Sustained Ventricular Tachycardia with Cardiac Arrest and Myocardial Infarction in 29-Year-Old Man Addicted to Medical Marijuana—It Never Rains but It Pours

“…Another potentially life-threatening complication of marijuana is myocardial infarction. The mechanisms leading to acute myocardial ischemia cover artery vasospasm and dissection, vasculitis, increased platelet aggregation and coronary artery thrombosis, autonomic nervous system imbalance, oxidative stress, endothelial injury and inflammation secondary to impurities and even hypertensive urgency from abrupt withdrawal [ 22 , 23 , 24 ]. Clinical manifestation varies from angina to cardiac arrest.…”

Marijuana and Coronary Dissection: A Case Report and Review of Literature

“…Few scattered cases of SCAD have also been reported with the use of recreational drugs like cocaine [ 11 ], methamphetamine [ 12 ] and marijuana [ 13 , 14 , 15 , 16 , 17 ]. Marijuana has been implicated as causative in a wide spectrum of cardiac disorders which range from ACS, coronary spasm, myocarditis to arrhythmias [ 18 , 19 , 20 , 21 , 22 , 23 ]. However, the presentation of SCAD with marijuana has rarely been reported.…”