Recurrent STEMI Precipitated by Marijuana Use: Case Report and Literature Review

Perry Wengrofsky¹, Ghassan Mubarak¹, Ahmed Shim², Pramod Theetha Kariyanna², Adam Buzidkowski², Jacob Schwartz¹ and Samy I. McFarlane^1,

¹Department of Internal Medicine, State University of New York, Downstate Medical Center, Brooklyn, N.Y, U.S.A-11203

²Division of Cardiovascular Disease, Department of Internal Medicine, State University of New York, Downstate Medical Center, Brooklyn, N.Y, U.S.A-11203

Cite this paper

Perry Wengrofsky, Ghassan Mubarak, Ahmed Shim, Pramod Theetha Kariyanna, Adam Buzidkowski, Jacob Schwartz and Samy I. McFarlane. Recurrent STEMI Precipitated by Marijuana Use: Case Report and Literature Review. American Journal of Medical Case Reports. 2018; 6(8):163-168. doi: 10.12691/AJMCR-6-8-5

Abstract

Marijuana abuse is rapidly growing and currently it is the most common drug of abuse in the United States due to increased legalization for recreational and medicinal use. Delta 9-tetrahydrocannibol, the main psychoactive compound in marijuana, acts via the endocannabinoid system to elicit various cardiovascular physiological effects, and has been associated with many adverse cardiovascular effects such as acute coronary syndrome, arrhythmias, and sudden cardiac death that have previously been reported by our group and others. We present a case of a 30-year-old African-American male with no cardiovascular disease (CVD) risk factors with recurrent ST-segment elevation myocardial infarctions (STEMI) whose coronary angiography revealed recurrent 100% occlusion of the left anterior descending artery (LAD) in the setting of marijuana smoking. It was the patient’s third STEMI with 100% occlusion of the LAD with each STEMI secondary to thrombosis of a different region of the LAD. Marijuana use was confirmed by urine toxicology screening at each STEMI presentation. Coronary angiography on multiple occasions was negative for stenosis of other epicardial coronary arteries, and coronary calcium scoring was zero. Evaluation for other cardiovascular risk factors including family history of premature coronary artery disease, dyslipidemia, diabetes, and hypercoagulable disorders was negative. Further studies are required to elucidate the mechanisms of marijuana-associated coronary thrombosis and myocardial infarction.

Keywords

Marijuana, cannabis, ST-segment myocardial infarction, STEMI

Copyright

This work is licensed under a Creative Commons Attribution 4.0 International License. To view a copy of this license, visit http://creativecommons.org/licenses/by/4.0/

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