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Echeverria-Villalobos M, Guevara Y, Mitchell J, Ryskamp D, Conner J, Bush M, Periel L, Uribe A, Weaver TE. Potential perioperative cardiovascular outcomes in cannabis/cannabinoid users. A call for caution. Front Cardiovasc Med 2024; 11:1343549. [PMID: 38978789 PMCID: PMC11228818 DOI: 10.3389/fcvm.2024.1343549] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2023] [Accepted: 05/15/2024] [Indexed: 07/10/2024] Open
Abstract
Background Cannabis is one of the most widely used psychoactive substances. Its components act through several pathways, producing a myriad of side effects, of which cardiovascular events are the most life-threatening. However, only a limited number of studies address cannabis's perioperative impact on patients during noncardiac surgery. Methods Studies were identified by searching the PubMed, Medline, EMBASE, and Google Scholar databases using relevant keyword combinations pertinent to the topic. Results Current evidence shows that cannabis use may cause several cardiovascular events, including abnormalities in cardiac rhythm, myocardial infarction, heart failure, and cerebrovascular events. Additionally, cannabis interacts with anticoagulants and antiplatelet agents, decreasing their efficacy. Finally, the interplay of cannabis with inhalational and intravenous anesthetic agents may lead to adverse perioperative cardiovascular outcomes. Conclusions The use of cannabis can trigger cardiovascular events that may depend on factors such as the duration of consumption, the route of administration of the drug, and the dose consumed, which places these patients at risk of drug-drug interactions with anesthetic agents. However, large prospective randomized clinical trials are needed to further elucidate gaps in the body of knowledge regarding which patient population has a greater risk of perioperative complications after cannabis consumption.
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Affiliation(s)
| | - Yosira Guevara
- Department of Anesthesiology, St Elizabeth’s Medical Center, Brighton, MA, United States
| | - Justin Mitchell
- Department of Anesthesiology & Perioperative Medicine, UCLA Medical Center, Los Angeles, CA, United States
| | - David Ryskamp
- Department of Anesthesiology, The Ohio State University Wexner Medical Center, Columbus, OH, United States
| | - Joshua Conner
- Department of Anesthesiology, The Ohio State University Wexner Medical Center, Columbus, OH, United States
| | - Margo Bush
- University of Toledo, College of Medicine and Life Sciences, Toledo, OH, United States
| | - Luis Periel
- Touro College of Osteopathic Medicine, New York, NW, United States
| | - Alberto Uribe
- Department of Anesthesiology, The Ohio State University Wexner Medical Center, Columbus, OH, United States
| | - Tristan E. Weaver
- Department of Anesthesiology, The Ohio State University Wexner Medical Center, Columbus, OH, United States
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Padda I, Mahtani AU, Farid M, Fabian D, Nigussie B, Piccione G, Kavarthapu A, Sethi Y, Htyte N. Marijuana-induced ST-elevation myocardial infarction in adolescents and young adults: A case report and comprehensive review of literature. Curr Probl Cardiol 2024; 49:102225. [PMID: 38040213 DOI: 10.1016/j.cpcardiol.2023.102225] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2023] [Revised: 11/27/2023] [Accepted: 11/28/2023] [Indexed: 12/03/2023]
Abstract
As per the Centers for Disease Control and Prevention (CDC), the incidence of myocardial infarction (MI) is reported to be 805,000 cases annually in the United States (US). Although commonly occurring in elderly individuals with underlying cardiovascular comorbidities or younger generations with familial predispositions serving as risk factors, it is extremely rare for an isolated event to occur in teenagers with a history of marijuana use. In this article, we report a rare case of ST-elevation myocardial infarction (STEMI) in a 19-year-old male with no past medical history that was attributed to marijuana use. This case report and review of literature depict a potential association between marijuana use and STEMI. We also highlight potential clinical implications to aid healthcare professionals in making an early diagnosis and achieving a timely management strategy.
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Affiliation(s)
- Inderbir Padda
- Department of Medicine, Richmond University Medical Center/Mount Sinai, Staten Island, NY, United States
| | - Arun Umesh Mahtani
- Department of Medicine, Richmond University Medical Center/Mount Sinai, Staten Island, NY, United States
| | - Meena Farid
- Department of Medicine, Richmond University Medical Center/Mount Sinai, Staten Island, NY, United States
| | - Daniel Fabian
- Department of Medicine, Richmond University Medical Center/Mount Sinai, Staten Island, NY, United States
| | - Bisrat Nigussie
- Department of Cardiology, State University New York Downstate Medical Center, Brooklyn, NY, United States
| | - Gianpaolo Piccione
- Department of Medicine, Richmond University Medical Center/Mount Sinai, Staten Island, NY, United States
| | - Anusha Kavarthapu
- Department of Medicine, Richmond University Medical Center/Mount Sinai, Staten Island, NY, United States
| | - Yashendra Sethi
- PearResearch, Dehradun, India; Department of Medicine, Government Doon Medical College, HNB Uttarakhand Medical Education University, 67/31 Tyagi Road, Dehradun 248001, India.
| | - Nay Htyte
- Department of Cardiology, Richmond University Medical Center/Mount Sinai, Staten Island, NY, United States
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Jafry AH, LaGrow A, Akhtar KH, Hacker E, Russell S, Kliewer B, Asad ZUA. Synthetic cannabinoids and ST elevation myocardial infarction. Am J Med Sci 2022; 364:481-491. [PMID: 35545143 DOI: 10.1016/j.amjms.2022.05.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2021] [Revised: 03/16/2022] [Accepted: 05/02/2022] [Indexed: 01/25/2023]
Abstract
Synthetic cannabinoids cannot be detected on a standard urine drug screen (UDS), making them a convenient drug of abuse. We report the first case of ST elevation myocardial infarction (STEMI) in a young patient due to coronary artery thrombosis secondary to synthetic cannabinoid use and concurrent COVID-19 infection. A 38-year-old previously healthy male developed severe chest pain and was found to have anterior STEMI and COVID-19 infection. Coronary angiography showed acute thrombotic occlusion of the mid-left anterior descending artery that was managed with thrombectomy and stent placement. He only required supportive care for COVID-19. A comprehensive literature search revealed 34 additional cases of STEMI with synthetic cannabinoid use; majority were males (97%) with mean age of 29 years. 29 patients (85.3%) underwent coronary angiography and majority had left anterior descending artery (LAD) involvement (55%), with 13 (44.8%) undergoing stent placement. We highlight STEMI as a potentially lethal complication of synthetic cannabinoids; prompt angiography may be lifesaving.
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Affiliation(s)
- Ali Haider Jafry
- Department of Medicine, University of Oklahoma Health Sciences Center, Oklahoma City, Oklahoma, United States.
| | - Austin LaGrow
- Department of Medicine, University of Oklahoma Health Sciences Center, Oklahoma City, Oklahoma, United States
| | - Khawaja Hassan Akhtar
- Department of Medicine, University of Oklahoma Health Sciences Center, Oklahoma City, Oklahoma, United States
| | - Ethan Hacker
- Department of Medicine, University of Oklahoma Health Sciences Center, Oklahoma City, Oklahoma, United States
| | - Sage Russell
- Department of Medicine, University of Oklahoma Health Sciences Center, Oklahoma City, Oklahoma, United States
| | - Brian Kliewer
- Department of Medicine, University of Oklahoma Health Sciences Center, Oklahoma City, Oklahoma, United States
| | - Zain Ul Abideen Asad
- Department of Medicine, University of Oklahoma Health Sciences Center, Oklahoma City, Oklahoma, United States
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Chetty K, Lavoie A, Deghani P. A Literature Review of Cannabis and Myocardial Infarction-What Clinicians May Not Be Aware Of. CJC Open 2021; 3:12-21. [PMID: 33458628 PMCID: PMC7801213 DOI: 10.1016/j.cjco.2020.09.001] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2020] [Accepted: 09/01/2020] [Indexed: 12/11/2022] Open
Abstract
Increasing legalization and expanding medicinal use have led to a significant rise in global cannabis consumption. With this development, we have seen a growing number of case reports describing adverse cardiovascular events, specifically, cannabis-induced myocardial infarction (MI). However, there are considerable knowledge gaps on this topic among health care providers. This review aims to provide an up-to-date review of the current literature, as well as practical recommendations for clinicians. We also focus on proposed mechanisms implicating cannabis as a risk factor for MI. We performed a comprehensive literature search using the MEDLINE, Cochrane, Cumulative Index to Nursing and Allied Health Literature (CINAHL), and Turning Research into Practice (TRIP) PRO databases for articles published between 2000 and 2018. A total of 92 articles were included. We found a significant number of reports describing cannabis-induced MI. This was especially prevalent among young healthy patients, presenting shortly after use. The most commonly proposed mechanisms included increased autonomic stimulation, altered platelet function, vasospasm, and direct toxic effects of smoke constituents. However, it is likely that the true pathogenesis is multifactorial. We should increase our pretest probability for MI in young patients presenting with chest pain. We also recommend against cannabis use in patients with known coronary artery disease, especially if they have stable angina. Finally, if patients are adamant about using cannabis, health care providers should recommend against smoking cannabis, avoidance of concomitant tobacco use, and use of the lowest delta-9-tetrahydrocannabinol dose possible. Data quality is limited to that of observational studies and case report data. Therefore, more clinical trials are needed to determine a definitive cause-and-effect relationship.
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Affiliation(s)
| | - Andrea Lavoie
- Department of Cardiology, University of Saskatchewan, Saskatoon, Saskatchewan, Canada
| | - Payam Deghani
- Department of Cardiology, University of Saskatchewan, Saskatoon, Saskatchewan, Canada
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Patel RS, Kamil SH, Bachu R, Adikey A, Ravat V, Kaur M, Tankersley WE, Goyal H. Marijuana use and acute myocardial infarction: A systematic review of published cases in the literature. Trends Cardiovasc Med 2019; 30:298-307. [PMID: 31439383 DOI: 10.1016/j.tcm.2019.08.003] [Citation(s) in RCA: 32] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/28/2019] [Revised: 08/07/2019] [Accepted: 08/09/2019] [Indexed: 12/28/2022]
Abstract
BACKGROUND AND OBJECTIVE Marijuana use has gained popularity following legalization in the US. Marijuana can affect the heart through various mechanisms. This study aims to conduct a systematic review of published case reports of individuals with acute myocardial infarction (AMI) following marijuana use. METHODS We conducted a systematic review of literature, including case reports, case series, and the letter to the editor on MEDLINE. Forty-six studies were included, with a total number of 62 patients with AMI and marijuana use. RESULTS The mean age was 27.7 (±10.3) years with male predominance. About 3.7 g marijuana was used for an average of 9.7 years by the patients. From the cases reporting the onset of AMI symptoms, the average time was within 5 h after last marijuana use. The angiographic findings were normal in 36.8% of cases. In 42.1% of individuals, the left anterior descending coronary artery was occluded, making it the most common artery involved, followed by the right coronary artery (10.5%). Most cases were managed medically, followed by thrombectomy and stent placement, and percutaneous transluminal coronary angioplasty (PTCA). Complications included cardio-embolic stroke, and seven deaths were reported. CONCLUSION It is important to consider episodic marijuana use as a significant risk factor of AMI, particularly in individuals with no cardiac risk factors, as delay in management can result in fatal outcomes including increased risk of mortality.
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Affiliation(s)
- Rikinkumar S Patel
- Department of Psychiatry, Griffin Memorial Hospital and Oklahoma Department of Mental Health and Substance abuse (ODMHAS), Norman, OK 73071, USA
| | - Saher H Kamil
- Department of Psychiatry, Austin State Hospital, Austin, TX 78751, USA
| | - Ramya Bachu
- Department of Medicine, Baptist Health Medical Center, North Little Rock, AR 72117, USA
| | - Archana Adikey
- Department of Psychiatry, Virginia Tech Carilion Clinic, Roanoke, VA 24018, USA
| | - Virendrasinh Ravat
- Department of Medicine, Larkin Community Hospital, South Miami, FL 33143, USA
| | - Mandeep Kaur
- American University of Antigua, Jabberwock Beach Road PO Box W1451 Coolidge, Antigua
| | - William E Tankersley
- Department of Psychiatry, Griffin Memorial Hospital and Oklahoma Department of Mental Health and Substance abuse (ODMHAS), Norman, OK 73071, USA
| | - Hemant Goyal
- Department of Medicine, The Wright Center of Graduate Medical Education, Scranton, PA 18503, USA.
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Ozturk HM, Erdogan M, Alsancak Y, Yarlioglues M, Duran M, Boztas MH, Murat SN, Ozturk S. Electrocardiographic alterations in patients consuming synthetic cannabinoids. J Psychopharmacol 2018; 32:296-301. [PMID: 29108464 DOI: 10.1177/0269881117736918] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
INTRODUCTION The aim of this study was to investigate the electrocardiographic parameters in patients consuming synthetic cannabinoids. METHODS Thirty-five patients who were consuming synthetic cannabinoids were enrolled to the study, prospectively. The control group included 35 healthy age and sex-matched volunteers. The standard 12-lead surface electrocardiograms of the study population were recorded. P maximum (Pmax), P minimum (Pmin), P wave dispersion, interatrial duration, P wave area in D2 derivation, abnormal P terminal force in V1 derivation, heart rate, QT interval, corrected QT, QT dispersion, PR interval duration and macrovolt T-wave alternans were evaluated by two experienced cardiologists. The intra-observer and inter-observer variations for all measurements were non-significant. RESULTS Pmax and Pmin duration was not different between the groups ( p=0.96, p=0.15, respectively). However, P wave dispersion was higher in the patient group compared to control group (34±9.4, 29.5±6.6, p=0.02, respectively). QT interval was significantly higher in the patient group than the control group (380.3±25, 365.6±22.8, p=0.01, respectively). Besides, corrected QT was higher in the patient group compared to control group (415±36.8, 392±15.5, p=0.001, respectively). QT dispersion was also higher in the patient group than the control group (39.8±10.0, 29.2±5.4, p<0.001, respectively). CONCLUSION Altered electrocardiography parameters linked with atrial and ventricular arrhythmia development may be observed in patients consuming synthetic cannabinoids. These patients should be evaluated regularly for cardiovascular disease and arrhythmia development. The electrocardiogram, which is a cheap and easy test to apply, can be used to determine the pro-arrythmic risk in patients consuming synthetic cannabinoids.
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Affiliation(s)
- Hayriye M Ozturk
- 1 Department of Psychiatry, Ankara Numune Education and Research Hospital, Turkey
| | - Mehmet Erdogan
- 2 Department of Cardiology, Ankara Education and Research Hospital, Turkey
| | - Yakup Alsancak
- 3 Department of Cardiology, Ankara Atatürk Education and Research Hospital, Turkey
| | - Mikail Yarlioglues
- 2 Department of Cardiology, Ankara Education and Research Hospital, Turkey
| | - Mustafa Duran
- 2 Department of Cardiology, Ankara Education and Research Hospital, Turkey
| | - M Hamid Boztas
- 4 Department of Psychiatry, Abant Izzet Baysal University Izzet Baysal Mental Health and Disorders Education and Research Hospital, Bolu, Turkey
| | - Sani N Murat
- 2 Department of Cardiology, Ankara Education and Research Hospital, Turkey
| | - Selcuk Ozturk
- 2 Department of Cardiology, Ankara Education and Research Hospital, Turkey
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