Suspected Cannabis-Induced Acute Coronary Syndrome and Advanced Heart block

Area of Science:

• Cardiology
• Pharmacology
• Public Health

Background:

• Cannabis use is increasingly prevalent globally.
• The cardiovascular effects of cannabis, particularly in acute coronary syndromes (ACS), require further elucidation.
• Associations between cannabis and cardiovascular events, including myocardial infarction, have been reported but are not fully understood.

Purpose of the Study:

• To report a case of ST-segment-elevation acute coronary syndrome (STE-ACS) with advanced heart block in a patient with a history of significant cannabis consumption.
• To emphasize the potential association between active cannabis use and acute cardiac events.
• To raise clinician awareness regarding cannabis use in patients presenting with ACS.

Main Methods:

• Case report of a 35-year-old Caribbean-Black male.
• Clinical presentation of inferior STE-ACS with advanced heart block during active cannabis consumption.
• Management included primary percutaneous coronary intervention (PCI) with aspiration thrombectomy, drug-coated balloon angioplasty, and guideline-directed medical therapy with direct oral anticoagulation.

Main Results:

• Cineangiography revealed significant thrombus burden in the right coronary artery's first acute marginal branch.
• The patient successfully underwent revascularization and medical management.
• The event occurred during active cannabis consumption, suggesting a potential trigger or contributing factor.

Conclusions:

• Clinicians should maintain a high index of suspicion for cannabis-associated acute coronary syndrome.
• Both acute and chronic cannabis consumption may be linked to ACS.
• Further research is warranted to understand the mechanisms underlying the association between cannabis and cardiovascular events.