Why the study?
While the effects of marijuana on the heart are well known, coronary artery vasospasm causing STEMI from marijuana alone is lesser known.
This case highlights the importance of considering marijuana-induced coronary vasospasm as an etiology for STEMI during initial presentation.
Marijuana use warrants consideration in STEMI differentials; case report leaves open need for prospective studies on prevalence and mechanisms.
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.
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Kariyanna et al. (2020) studied this question.
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