Recreational Marijuana Use and Coronary Artery Dissection: A Case Series

The cardiovascular effects of marijuana have been shown to be a result of the activation of the CB1 and CB2 receptors located in the myocardium and coronary vasculatures. Adverse cardiovascular consequences of recreational use of marijuana and synthetic cannabinoids include stroke, artery dissection, vasospasm, vasculitis, coronary artery thrombosis, myocarditis/pericarditis, postural hypotension, arrhythmias, and acute heart failure. With marijuana being legalized for medicinal purposes and recreational use in more and more states in the United States, physicians should have a low threshold for the possibility of marijuana being the underlying cause of adverse cardiovascular events. Marijuana has been established to increase sympathetic tone and cause blood pressure elevations and severe coronary artery spasm (CAS). Some studies have even indicated that the risks of heart attack, atrial fibrillation, and ischemic stroke are several times higher within an hour of marijuana use. This case series discusses three female patients, aged 27, 39, and 53 years, who were known to smoke marijuana consistently. These patients all presented with signs and symptoms of acute coronary syndrome (ACS) less than 12 hours after smoking recreational marijuana. All patients endorsed smoking marijuana a few hours prior to the onset of chest pain and less than 12 hours prior to the presentation, which was confirmed by a positive urine drug screen (UDS). Coronary artery angiograms revealed coronary artery dissection in the proximal left circumflex (LCX) artery, the mid-distal left anterior descending (LAD) artery, and mid-LAD in the 27 y/o, 39 y/o, and 53 y/o patients respectively. The average age of spontaneous coronary artery dissection (SCAD) cases ranges between 35-40 years. Women account for more than 70% of cases; it is thought to be due to higher levels of estrogen in women, which alters the normal arterial wall architecture. Additionally, the excessive use of marijuana resulting in CAS further increases the susceptibility to spontaneous dissection in female patients.