Coronary no-flow and ventricular tachycardia associated with habitual marijuana use

doi:10.1016/S0196-0644(03)00426-8

Annals of Emergency Medicine

Volume 42, Issue 3, September 2003, Pages 365-369

https://doi.org/10.1016/S0196-0644(03)00426-8 Get rights and content

Abstract

A 34-year-old man reported heart fluttering and near syncope a few hours after marijuana smoking. In the emergency department, he was found to have a right bundle-branch–type ventricular tachycardia. The patient underwent a successful electric cardioversion. Coronary angiography showed no pericardial artery stenosis yet very slow coronary blood flow. Clinical tachycardia was also inducible in the electrophysiologic laboratory. After verapamil therapy and cessation of marijuana, his coronary flow normalized and ventricular tachycardia was no longer inducible in the electrophysiologic laboratory. Marijuana use might affect coronary microcirculation and cause ventricular tachycardia. Verapamil therapy and cessation of smoking might be curative.

Introduction

Marijuana smoking is a widespread habit. Contrary to other addictive drugs, its use is perceived to be safe and might even have some therapeutic potential. Marijuana use has been linked to myocardial infarction and sudden death, but no definite mechanism has been established. Most patients appear to have normal coronary arteries at angiography or at autopsy. We report the case of a 34-year-old man with habitual marijuana use who had ventricular tachycardia. Angiography revealed a significant decrease in coronary flow, and clinical ventricular tachycardia was inducible at electrophysiologic testing. After verapamil therapy and cessation of marijuana use, his coronary flow normalized, and ventricular tachycardia was no longer inducible. Abnormalities of coronary microcirculation are a plausible theory for marijuana-induced cardiac events.

Section snippets

Case report

We report the case of a 34-year-old man who reported occasional “heart fluttering” with dizziness for the past several months. On the day of admission, he was working in his garden when he experienced palpitations, shortness of breath, chest pain, and near syncope. The patient smoked less than half a pack of cigarettes per day. He smoked marijuana twice a day, using a glass pipe. He usually consumed one-quarter to one-half ounces a week, and the last time he smoked marijuana was 3 hours before

Discussion

Cannabis is available in 3 main forms: dried herb from top leaves and buds, a resin (hash) extracted from the buds and flower heads, and a hash oil prepared from the resin.¹ All forms can be ingested through different routes, yet the most common route is smoking either the pure substance or the pure substance mixed with tobacco leaves.

Contrary to most addictive drugs, marijuana is perceived by some to be safe, without any significant cardiovascular effects. Occasional cases of myocardial

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Cited by (88)

Impact of Cannabis Use on Outcomes after Lower Extremity Bypass
2023, Annals of Vascular Surgery
Cannabis is one of the most commonly used substances in the United States, with national use on the rise. However, there is a paucity of data regarding the effects of cannabis and surgical outcomes. The aim of this study was to assess the association of cannabis use on postoperative outcomes after lower extremity bypass.
We queried a large statewide registry from 2014 to 2021 to assess patients who underwent lower extremity bypass procedures. Data were gathered regarding cannabis use and the association with postoperative outcomes at 30 days and 1 year.
A total of 11,013 patients were identified. Ninety-one percent of patients (10,024) reported no cannabis use, whereas 9.0% (989) reported cannabis use in the past month. Compared with noncannabis users, patients using cannabis had higher opioid use at discharge (odds ratio [OR]: 1.56, 95% confidence interval [CI]: 1.28–1.90), decreased bypass patency at 30 days (OR: 0.52, 95% CI: 0.36–0.78) and 1 year (OR: 0.64, 95% CI 0.47–0.86), and an increased amputation rate at 1 year (OR: 1.25, 95% CI: 1.02–1.52) after lower extremity bypass.
This study shows that cannabis use in vascular surgical patients was associated with decreased graft patency, increased amputation, and increased opioid use after lower extremity bypass procedures. Although future studies are needed, the present study provides novel data that can be used to counsel patients undergoing vascular surgery.
Drugs of Misuse: Focus on Vascular Dysfunction
2022, Canadian Journal of Cardiology
Common drugs of misuse, including cannabis, opioids, stimulants, alcohol, and anabolic steroids, have strikingly disparate acute and chronic vascular effects, leading to a wide range of clinical cardiovascular presentations. Acute cannabis smoking has been associated with increased risk for myocardial infarction and ischemic stroke in otherwise healthy young people. However, it remains uncertain if people who exclusively smoke cannabis have increased risk for accelerated atherosclerosis similar to that found in people who exclusively smoke tobacco cigarettes. Cocaine and methamphetamines, both stimulants, increase risk for stroke, myocardial infarction, aortic dissection, and accelerated atherosclerosis, but only methamphetamine use is strongly linked to pulmonary hypertension. Chronic alcohol use is strongly associated with chronic hypertension and hemorrhagic stroke, but perhaps confers a lower risk for myocardial infarction. Finally, anabolic steroid use, presumably through adverse effects on circulating lipids and the hematopoietic system, is associated with increased risk for accelerated atherosclerosis and myocardial infarction. Physicians, especially cardiologists, emergency medicine, and internal medicine physicians, should be familiar with the short- and long-term vascular consequences of use of these substances, thereby ensuring appropriate, specific, and informed counselling and treatment.
Les substances addictives courantes, comme le cannabis, les opioïdes, les stimulants, l’alcool et les stéroïdes anabolisants, ont des effets vasculaires aigus et chroniques étonnamment disparates, ce qui se traduit par différentes manifestations cliniques cardiovasculaires. La consommation aiguë de cannabis inhalé a été associée à une augmentation du risque d’infarctus du myocarde et d’AVC ischémique chez des jeunes par ailleurs en bonne santé. Toutefois, on ne sait toujours pas avec certitude si les personnes qui fument exclusivement du cannabis présentent un risque plus élevé d’athérosclérose accélérée analogue à celui observé chez les personnes qui fument exclusivement des cigarettes. La cocaïne et les méthamphétamines sont des stimulants qui augmentent le risque d’AVC, d’infarctus du myocarde, de dissection aortique et d’athérosclérose accélérée, mais seule la consommation de méthamphétamines est fortement corrélée à l’hypertension pulmonaire. La consommation chronique d’alcool est fortement associée à l’hypertension chronique et à l’AVC hémorragique, mais elle se traduit peut-être par un risque plus faible d’infarctus du myocarde. Enfin, l’utilisation de stéroïdes anabolisants, probablement en raison d’effets indésirables sur les lipides circulants et sur le système hématopoïétique, est associée à une augmentation du risque d’athérosclérose accélérée et d’infarctus du myocarde. Les médecins, particulièrement les cardiologues, les urgentologues et les internistes, se doivent d’être au fait des conséquences vasculaires que l’utilisation de ces substances entraîne à court et à long terme, pour ainsi être en mesure de conseiller et de traiter leurs patients de façon éclairée.
Self-reported marijuana use and cardiac arrhythmias (from the Multiethnic Study of Atherosclerosis)
2022, American Journal of Cardiology
Marijuana use among all age groups has been increasing, including among older adults aged ≥65 years. There is a lack of epidemiologic data examining arrhythmia risk among users of marijuana. We evaluated cross-sectional associations between current and past marijuana smoking and arrhythmias among 1485 participants from the Multiethnic Study of Atherosclerosis who underwent extended ambulatory electrocardiographic monitoring with the Zio Patch XT. Outcomes included premature atrial contractions, runs of supraventricular tachycardia, premature ventricular contractions, and runs of nonsustained ventricular tachycardia (NSVT). Compared with never users, participants reporting current use of marijuana (n = 40, 3%) had more supraventricular tachycardia/day (adjusted geometric mean ratio [GMR] 1.42, 95% confidence interval [CI] 0.87 to 2.32), more premature atrial contractions/hour (GMR 1.22, 95% CI 0.72, 2.13), and more NSVT/day (GMR 1.28, 95% CI 0.95 to 1.73); although, CIs overlapped 1. Additionally, more frequent marijuana use was associated with more runs of NSVT/day (GMR 1.56, 95% CI 1.13, 2.17).
In conclusion, our results suggest that current marijuana use may be associated with a greater burden of arrhythmias. There is a need for additional research, mainly using a prospective design, to clarify if marijuana use causes atrial and ventricular arrhythmias or other cardiovascular complications among older adults.
Toxins and the heart
2022, Cardiovascular Pathology
For the purposes of this chapter, toxic agents refer to medicine, recreational drugs, and substances present in food, drink, nutritional supplements, or the environment. In general, agents that are “toxic” to the heart induce injury through one (or more) of the following mechanisms: direct toxicity, idiosyncratic reaction related to abnormal metabolism, hypersensitivity, overdose, and/or drug interactions. The heart has a very limited repertoire of responses to disease: (1) the heart can fail as a pump or (2) the electrical system can fail, resulting in a variety of conduction problems and arrhythmias. Therefore when a drug affects the cardiovascular system, the complication cannot be considered minor, as the consequence is likely to affect cardiac contractile function or rhythm. Some adverse drug reactions may demonstrate a predilection for injury to certain anatomic areas of the heart, but patterns of injury can be quite variable and cardiotoxic effects are seldom purely isolated. Many drugs are known to act on a variety of different structures of the heart causing a multitude of patterns of injury.
The growing dilemma of legalized cannabis and heart transplantation
2021, Journal of Heart and Lung Transplantation
This in-depth review discusses cannabis as it relates to heart transplantation and the growing dilemma of legalization around the world creating disparities in transplant candidacy. One will learn about two of the most common cannabinoids: Δ⁹-tetrahydrocannabinol (THC) and cannabidiol (CBD). These cannabinoids are metabolized by cytochrome P-450 and P glycoprotein, which are essential for the metabolism of drugs for transplantation, such as calcineurin inhibitors. Addiction, withdrawal, and cannabis use disorder will be reviewed as well as hyperemesis syndrome. Maintaining adequate immunosuppression will depend on a variety of factors, including drug-drug interactions, pharmacokinetics of cannabinoids and chronicity of cannabis usage. These drug interactions are further confounded by varying concentrations of cannabis products available at medical dispensaries. One will also learn about the outcomes of transplant recipients using cannabis such as graft failure and the risk of infections. Although more research is needed to establish transplant guidelines, the available data is concerning and fairness in organ distribution should not vary by transplant program or institution.
Cannabis use disorder and perioperative outcomes in vascular surgery
2021, Journal of Vascular Surgery
Heavy cannabis use is known to have an adverse impact on cardiovascular and cerebrovascular outcomes in the general population and in patients presenting for surgery. However, there have been no studies that have focused on patients undergoing vascular surgical procedures. The objective of this study was to determine the perioperative risk of cannabis use disorder (CUD), primarily cardiovascular risk, in perioperative vascular surgery patients.
Using the National Inpatient Sample from 2006 to 2015, we conducted a retrospective cohort study involving those undergoing one of six elective and emergent vascular surgical procedures (carotid endarterectomy [CEA], infrainguinal bypasses, open abdominal aortic aneurysm repair, aortobifemoral bypass, endovascular aortic aneurysm repair, or peripheral arterial endovascular procedures). Patients with CUD identified by the International Classification of Diseases, 9th edition, were matched with patients without CUD in a 1:1 ratio using propensity scores. The primary outcome was perioperative myocardial infarction (MI). Secondary outcomes include stroke, sepsis, deep vein thrombosis, pulmonary embolus, acute kidney injury requiring dialysis, respiratory failure, in-hospital mortality, total cost, and length of stay.
We identified a total cohort of 510,007 patients. Over the study period, the recorded prevalence of CUD increased from 1.3/1000 to 10.3/1000 admissions (P < .001). After propensity score matching the cohort consisted of 4684 patients. Those with CUD had a higher incidence of perioperative MI (3.3% vs 2.1%; odds ratio [OR], 1.56; 95% confidence interval [CI], 1.09-2.24; P = .016) and perioperative stroke (5.5% vs 3.5%; OR, 1.59; 95% CI, 1.20-2.12; P = .0013) than patients without CUD. In a sensitivity analysis, where the risk was evaluated separately by type of procedure, the higher incidence of perioperative stroke was primarily seen among those undergoing CEA. Patients with CUD had a lower incidence of sepsis (3.3% vs 5.1%; OR, 0.64; 95% CI, 0.47-0.85; P = .0024). We obtained similar results in a sensitivity analysis that included all patients in the complete unmatched cohort and adjusted for confounding using logistic regression models accounting for the survey design, although the findings of sepsis and stroke failed to reach statistical significance after correcting for multiple testing (MI P = .001; stroke P = .031; sepsis P = .009).
CUD was associated with a significantly higher incidence of perioperative MI in vascular surgery patients. Those with CUD had a greater incidence of diagnosis of acute perioperative stroke when undergoing CEA. Owing to limitations in administrative data, it is unclear if this represents a true effect or selection bias. These findings warrant further investigation in a prospective cohort.

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^☆: The authors report this study did not receive any outside funding or support.

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ToxicologyCoronary no-flow and ventricular tachycardia associated with habitual marijuana use☆

Abstract

Introduction

Section snippets

Case report

Discussion

Am J Med Sci.

Forensic Sci Int.

Am J Cardiol

Myocardial infarction and marijuana

Clin Toxicol

Myocardial infarction during marijuana smoking in a young female

Eur Heart J.

Triggering myocardial infarction by marijuana

Circulation

Cardiovascular effects of cannabinol during oral surgery

Anesth Analg.

Toxicology
Coronary no-flow and ventricular tachycardia associated with habitual marijuana use☆