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

Pramod Theetha Kariyanna1, Harshith Priyan Chandrakumar1, Alan Feit2, Isabel M. McFarlane2,

1#These authors contributed equally to this work.

2Department of Internal Medicine, Division of Cardiovascular Disease, State University of New York, Downstate Health Sciences Center, Brooklyn, N.Y, USA - 11203

American Journal of Medical Case Reports. 2020, 8(7), 216-220. DOI: 10.12691/ajmcr-8-7-14
Received March 12, 2020; Revised April 15, 2020; Accepted April 25, 2020

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.

Keywords:

marijuana, ST-segment elevation myocardial infarction, cannabinoid receptors, vascular endothelial dysfunction, demand ischemia
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