Title : Green alert: Myocardial infarction triggered by marijuana use
Abstract:
Background: The cardiovascular implications of marijuana use have gained increasing attention in recent medical literature. While chronic cannabis consumption has been linked to various cardiovascular events, comprehensive documentation of acute myocardial infarction in young adults without traditional risk factors remains limited.
Case Summary: This case report presents a 24-year-old male with a significant 9-year history of daily marijuana use who presented to the emergency department with acute chest pain. Clinical evaluation revealed a severe anterior ST-elevation myocardial infarction characterized by complete proximal left anterior descending (LAD) artery occlusion. Emergency intervention through percutaneous coronary intervention successfully restored arterial blood flow.
Diagnostic investigations provided critical insights into the patient's cardiovascular condition. Initial electrocardiogram demonstrated ST-segment elevations in anterior leads, accompanied by markedly elevated troponin levels. Transthoracic echocardiography revealed substantial left ventricular dilation with apical akinesis and a significantly reduced ejection fraction of 30-35%. Intravascular ultrasound (IVUS) notably showed an isolated plaque rupture within an otherwise normal coronary arterial tree, with the patient's urine toxicology screening confirming active marijuana metabolites.
Management and Outcome: Comprehensive management included emergent coronary intervention, deployment of a drug-eluting stent, and initiation of guideline-directed medical therapy. Post-procedural cardiac magnetic resonance imaging demonstrated a non-transmural infarction in the LAD distribution, with improved ejection fraction of 40%. Notably, the patient discontinued marijuana use during follow-up.
Clinical Significance: This case exemplifies the potential cardiovascular risks associated with chronic marijuana consumption, particularly in young adults without conventional risk factors. The presentation underscores the importance of comprehensive substance use history in evaluating acute coronary events and highlights the need for heightened clinical suspense when assessing young patients with chest pain.
Conclusion: The case reinforces emerging evidence suggesting that chronic marijuana use can precipitate severe cardiovascular complications. It emphasizes the critical need for further research into the pathophysiological mechanisms underlying marijuana-induced cardiovascular events and advocates for comprehensive clinical assessment integrating substance use history.
