Hasaan Ahmed , Mahmoud Ismayl , Miranda Heppler , Terezia Petraskova , Omar Kousa , Ann E. Narmi , Toufik Mahfood Haddad
{"title":"大麻诱发左冠状动脉主干血管痉挛的罕见病例:病例报告和文献综述","authors":"Hasaan Ahmed , Mahmoud Ismayl , Miranda Heppler , Terezia Petraskova , Omar Kousa , Ann E. Narmi , Toufik Mahfood Haddad","doi":"10.1016/j.crmic.2024.100015","DOIUrl":null,"url":null,"abstract":"<div><h3>Background</h3><p>Left main coronary artery vasospasm is rare with a limited number of cases previously reported. Coronary artery vasospasm manifests as chest pain, which can result in acute coronary syndrome, ventricular arrhythmias, and death. While cannabis remains the most abused psychoactive substance, its association with coronary artery vasospasm remains unclear.</p></div><div><h3>Case summary</h3><p>A 46-year-old-female, with a history of recurrent angina and cannabis use, presented with severe chest pain. She suddenly entered ventricular fibrillation and was emergently cardioverted. Electrocardiogram showed ST segment elevations in leads aVR, V1, and V2 with reciprocal changes. Emergent coronary angiography revealed severe spasms of both the left main coronary artery and the left anterior descending artery. Intravenous nitroglycerin was initiated and her coronary artery vasospasms improved.</p></div><div><h3>Discussion</h3><p>Coronary artery vasospasm, due to cannabis, can be attributed to amplified catecholamine release causing vasoconstriction, presenting as decreased blood flow in coronary vessels, and increased myocardial oxygen demand due to a dose-dependent increase in cardiac output. Decreased anginal threshold combined with stimulation of pro-atherogenic CB1 receptors and hyper-sympathetic activity further propagates the risk of acute coronary syndrome.</p></div><div><h3>Conclusion</h3><p>Young patients presenting with coronary artery vasospasm should prompt the exclusion of cannabis as a contributing cause. Further studies are indicated to assess cannabis's impact on coronary vasculature.</p></div>","PeriodicalId":100217,"journal":{"name":"Cardiovascular Revascularization Medicine: Interesting Cases","volume":"2 ","pages":"Article 100015"},"PeriodicalIF":0.0000,"publicationDate":"2024-03-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S295027562400011X/pdfft?md5=8687938d6410959c940f16e0b1bca260&pid=1-s2.0-S295027562400011X-main.pdf","citationCount":"0","resultStr":"{\"title\":\"A Rare Case of Cannabis-Induced Left Main Coronary Artery Vasospasm: A Case Report and Review of Literature\",\"authors\":\"Hasaan Ahmed , Mahmoud Ismayl , Miranda Heppler , Terezia Petraskova , Omar Kousa , Ann E. Narmi , Toufik Mahfood Haddad\",\"doi\":\"10.1016/j.crmic.2024.100015\",\"DOIUrl\":null,\"url\":null,\"abstract\":\"<div><h3>Background</h3><p>Left main coronary artery vasospasm is rare with a limited number of cases previously reported. Coronary artery vasospasm manifests as chest pain, which can result in acute coronary syndrome, ventricular arrhythmias, and death. While cannabis remains the most abused psychoactive substance, its association with coronary artery vasospasm remains unclear.</p></div><div><h3>Case summary</h3><p>A 46-year-old-female, with a history of recurrent angina and cannabis use, presented with severe chest pain. She suddenly entered ventricular fibrillation and was emergently cardioverted. Electrocardiogram showed ST segment elevations in leads aVR, V1, and V2 with reciprocal changes. Emergent coronary angiography revealed severe spasms of both the left main coronary artery and the left anterior descending artery. Intravenous nitroglycerin was initiated and her coronary artery vasospasms improved.</p></div><div><h3>Discussion</h3><p>Coronary artery vasospasm, due to cannabis, can be attributed to amplified catecholamine release causing vasoconstriction, presenting as decreased blood flow in coronary vessels, and increased myocardial oxygen demand due to a dose-dependent increase in cardiac output. Decreased anginal threshold combined with stimulation of pro-atherogenic CB1 receptors and hyper-sympathetic activity further propagates the risk of acute coronary syndrome.</p></div><div><h3>Conclusion</h3><p>Young patients presenting with coronary artery vasospasm should prompt the exclusion of cannabis as a contributing cause. Further studies are indicated to assess cannabis's impact on coronary vasculature.</p></div>\",\"PeriodicalId\":100217,\"journal\":{\"name\":\"Cardiovascular Revascularization Medicine: Interesting Cases\",\"volume\":\"2 \",\"pages\":\"Article 100015\"},\"PeriodicalIF\":0.0000,\"publicationDate\":\"2024-03-08\",\"publicationTypes\":\"Journal Article\",\"fieldsOfStudy\":null,\"isOpenAccess\":false,\"openAccessPdf\":\"https://www.sciencedirect.com/science/article/pii/S295027562400011X/pdfft?md5=8687938d6410959c940f16e0b1bca260&pid=1-s2.0-S295027562400011X-main.pdf\",\"citationCount\":\"0\",\"resultStr\":null,\"platform\":\"Semanticscholar\",\"paperid\":null,\"PeriodicalName\":\"Cardiovascular Revascularization Medicine: Interesting Cases\",\"FirstCategoryId\":\"1085\",\"ListUrlMain\":\"https://www.sciencedirect.com/science/article/pii/S295027562400011X\",\"RegionNum\":0,\"RegionCategory\":null,\"ArticlePicture\":[],\"TitleCN\":null,\"AbstractTextCN\":null,\"PMCID\":null,\"EPubDate\":\"\",\"PubModel\":\"\",\"JCR\":\"\",\"JCRName\":\"\",\"Score\":null,\"Total\":0}","platform":"Semanticscholar","paperid":null,"PeriodicalName":"Cardiovascular Revascularization Medicine: Interesting Cases","FirstCategoryId":"1085","ListUrlMain":"https://www.sciencedirect.com/science/article/pii/S295027562400011X","RegionNum":0,"RegionCategory":null,"ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"","PubModel":"","JCR":"","JCRName":"","Score":null,"Total":0}
A Rare Case of Cannabis-Induced Left Main Coronary Artery Vasospasm: A Case Report and Review of Literature
Background
Left main coronary artery vasospasm is rare with a limited number of cases previously reported. Coronary artery vasospasm manifests as chest pain, which can result in acute coronary syndrome, ventricular arrhythmias, and death. While cannabis remains the most abused psychoactive substance, its association with coronary artery vasospasm remains unclear.
Case summary
A 46-year-old-female, with a history of recurrent angina and cannabis use, presented with severe chest pain. She suddenly entered ventricular fibrillation and was emergently cardioverted. Electrocardiogram showed ST segment elevations in leads aVR, V1, and V2 with reciprocal changes. Emergent coronary angiography revealed severe spasms of both the left main coronary artery and the left anterior descending artery. Intravenous nitroglycerin was initiated and her coronary artery vasospasms improved.
Discussion
Coronary artery vasospasm, due to cannabis, can be attributed to amplified catecholamine release causing vasoconstriction, presenting as decreased blood flow in coronary vessels, and increased myocardial oxygen demand due to a dose-dependent increase in cardiac output. Decreased anginal threshold combined with stimulation of pro-atherogenic CB1 receptors and hyper-sympathetic activity further propagates the risk of acute coronary syndrome.
Conclusion
Young patients presenting with coronary artery vasospasm should prompt the exclusion of cannabis as a contributing cause. Further studies are indicated to assess cannabis's impact on coronary vasculature.