Atrioventricular Nodal Reentrant Tachycardia Triggered by Marijuana Use: A Case Report and Review of the Literature

Pramod Theetha Kariyanna¹, Apoorva Jayarangaiah², Oleg Yurevich¹, Jonathan Francois³, Denis Yusupov³, Angelina Zhyvotovska³, Louis Salciccioli¹, Sudhanva Hegde¹ and Samy I. McFarlane^3,

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

²Department of Internal Medicine, NYC Health and Hospitals/Jacobi Medical Center, Bronx, N.Y., U.S.A- 10461

³Department of Internal Medicine, State University of New York, Downstate Medical Center, Brooklyn, N.Y, U.S.A-11203

Cite this paper:
Pramod Theetha Kariyanna, Apoorva Jayarangaiah, Oleg Yurevich, Jonathan Francois, Denis Yusupov, Angelina Zhyvotovska, Louis Salciccioli, Sudhanva Hegde and Samy I. McFarlane. Atrioventricular Nodal Reentrant Tachycardia Triggered by Marijuana Use: A Case Report and Review of the Literature. American Journal of Medical Case Reports. 2019; 7(9):193-196. doi: 10.12691/ajmcr-7-9-3

Abstract

Marijuana is the most commonly abused recreational substance. With the increasing legalization of marijuana, its use is expected to rise. Delta-9-tetrahydrocannabinol (THC) is the psychotropic component of marijuana, acting via CB1 and CB2 G-protein coupled cannabinoid receptors. Marijuana has serious cardiovascular effects including tachycardia, orthostatic hypotension, angina and myocardial infarction to name a few. Previous reports by our group and others documented various arrhythmias other than atrioventricular nodal reentrant tachycardia (AVNRT) that are associated with marijuana use. In this report, we present a case of AVNRT associated with marijuana use. Marijuana in high doses stimulates parasympathetic nerves. While parasympathetic stimulation can increase the refractory period of the fast conduction pathway, it has no effect on the slow and retrograde pathways, therefore its use creates an ideal milieu for AVNRT initiation and maintenance. Our case report highlights the importance of including marijuana use in the differential diagnosis, as a possible trigger, for patients presenting with AVNRT that is otherwise unexplainable.

Keywords:
marijuana arrhythmia avnrt

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