American Journal of Medical Case Reports
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American Journal of Medical Case Reports. 2020, 8(3), 79-82
DOI: 10.12691/ajmcr-8-3-4
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Myocardial Infarction Secondary to Marijuana-Induced Coronary Vasospasm

Krunal H. Patel1, Pramod Theetha Kariyanna2, Apoorva Jayarangaiah3, Nabila Khondakar1, Madina Abduraimova1 and Samy I. McFarlane1,

1Department of Internal Medicine, State University of New York, Downstate Medical Center, Brooklyn, NY, USA – 11203

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

3Department of Internal Medicine, NYC + HHC Jacobi Medical Center, 1400 Pelham Pkwy S, Bronx, NY, U.S.A- 10461

Pub. Date: January 18, 2020

Cite this paper:
Krunal H. Patel, Pramod Theetha Kariyanna, Apoorva Jayarangaiah, Nabila Khondakar, Madina Abduraimova and Samy I. McFarlane. Myocardial Infarction Secondary to Marijuana-Induced Coronary Vasospasm. American Journal of Medical Case Reports. 2020; 8(3):79-82. doi: 10.12691/ajmcr-8-3-4


With the rise of the number of states fully legalizing marijuana, the use of this substance in the United States is at an all-time high. This increasing legalization gives the impression that marijuana is rather safe. However, multiple reports by our groups and others documented serious cardiovascular complications associated with marijuana use ranging from life threatening arrhythmia to myocarditis and myocardial infarction. In this report, we present a case of a 61 year old man presented with left sided typical chest pain shortly after marijuana consumption with the diagnosis of non ST-elevation myocardial infarction (NSTEMI) established based on clinical, EKG and troponin values with eventual cardiac catheterization documenting non-occlusive coronary artery disease with 30% obstruction of the proximal first obtuse marginal artery. We also review the putative pathophysiologic mechanisms of marijuana induced coronary vasospasms, highlighting the implications of these findings in the evaluation and management of cardiac chest pain in marijuana users.

marijuana cannabis myocardial infarction vasospasm

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[1]  Hall K, Vigil D, Contreras E, Barker L, Berg K, Bol K, Dyke M. Monitoring Possible Marijuana Related Health Effects in Colorado. Colorado Hospital Association (CHA). 2016.
[2]  Matsuda LA, Lolait SJ, Brownstein MJ, Young CA, Bonner TI. Structure of a cannabinoid receptor and functional expression of the cloned cDNA. Nature (Lond). 1990; 346: 561.
[3]  Munro S, Thomas KL, Abu-Shaar M. Molecuar characterization of peripheral receptor for cannabinoids. Nature (Lond). 1993: 365: 61-65.
[4]  Rajesh, M., Mukhopadhyay, P., Haskó, G., Liaudet, L., Mackie, K. and Pacher, P. (2010), Cannabinoid-1 receptor activation induces reactive oxygen species-dependent and -independent mitogen-activated protein kinase activation and cell death in human coronary artery endothelial cells. British Journal of Pharmacology, 160: 688-700
[5]  Beltrame JF, Crea F, Kaski JC, et al. International standardization of diagnostic criteria for vasospastic angina. Eur Heart J 2017; 38(33):2565-2568, by permission of Oxford University Press on behalf of the European Society of Cardiology.
[6]  Kattoor A, Mehta J. Marijuana and Coronary Artery Disease. American College of Cardiology. Sep 22 2016.
[7]  Furchgott RF, Zawadzki JV. The obligatory role of endothelial cells in the relaxation of arterial smooth muscle by acetylcholine. Nature. 1980; 288:373-376.
[8]  Vanhoutte PM, Shimokawa H. Endothelium-derived relaxing factor and coronary vasospasm. Circulation. 1989; 80: 1-9.
[9]  Lanza G, Careri G, Crea F. Mechanisms of Coronary Artery Spasm. Circulation. 2011;124:1774-1782.
[10]  Wengrofsky, P., Mubarak, G., Shim, A., Kariyanna, P.T., Buzidkowski, A., Schwartz, J., McFarlane, S.I. Recurrent STEMI Precipitated by Marijuana Use: Case Report and Literature Review. AM J Med Case Report. 2018 Oct 5th. PMCID: PMC6173205.
[11]  Gunawardena, V.M., Rajapakse, S., Hearth, J., Amarasena, N., Myocardial Infarction Following Cannabis Induced Coronary Vasospasm. BMJ Case Reports. 2014. Nov 12th. PMCID: PMC4244407.
[12]  Rezkalla, S.H., Sharma, P., Kloner, R.A. Coronary No-Flow and Ventricular Tachycardia Associated with Habitual Marijuana Use. Annals of Emergency Medicine. (2003).
[13]  Horjeti B, Goda A. Acute ischemia manifestation in a patient with coronary slow flow phenomenon. J Electrocardiol 2012; 45: 277-9.
[14]  Cutri N, Zeitz C, Kucia AM, et al. ST/T wave changes during acute coronary syndrome presentation in patients with the coronary slow flow phenomenon. Int J Cardiol 2011; 146: 457-8.
[15]  Wozakowska-Kapłon B, Niedziela J, Krzyzak P, et al. Clinical manifestations of slow coronary flow from acute coronary syndrome to serious arrhythmias. Cardiol J 2009; 16: 462-8.
[16]  Saya S, Hennebry TA, Lozano P, et al. Coronary slow flow phenomenon and risk for sudden cardiac death due to ventricular arrhythmias: a case report and review of literature. Clinal Cardiology 2008; 31: 352-5.
[17]  Michael M, Breall J. No-Reflow Phenomenon During PCI. Cardiology. July 15th 2011.
[18]  Kariyanna P.T., Wengrofsky P, Jayarangaiah A, Haseeb S, Salciccioli L, et al. (2019) Marijuana and Cardiac Arrhythmias: A Scoping Study. Int J Clin Res Trials 4: 132.
[19]  Khouzam R, Kabra R, Soufi M. Marijuana, bigeminal premature ventricular contractions and sluggish coronary flow: Are they related? Journal of Cardiology Cases 8. 2013. June 28th. issues 121-124.
[20]  Alvarez C, Siu H. Coronary Slow-Flow Phenomenon as an Under recognized and Treatable Source of Chest Pain: Case Series and Literature Review. J iNvestig Med High Impact Case Rep. 2018 Jul 17th.
[21]  Amsterdam, E.A, Wenger, N.K., Brindis, R.G, CaseyJr, D.E, Ganiats, T.G, HolmesJr, D.R, Jaffe, A.S, Jneid, Hani, Kelly, R.F., Kontos, M.C, Levine, G.N, Liebson, P.R., Mukherjee, D., Peterson, E.D., Sabatine, M.S., Smalling, R.W., Zieman, S.J. (2014) AHA/ACC Guideline for the Management of Patients With Non-ST Elevation Acute Coronary Syndromes. Circulation. 2014. 130:e344-e426.