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

Hasaan Ahmed , Mahmoud Ismayl , Miranda Heppler , Terezia Petraskova , Omar Kousa , Ann E. Narmi , Toufik Mahfood Haddad
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引用次数: 0

摘要

背景冠状动脉左主干血管痉挛非常罕见,以前报道的病例数量有限。冠状动脉血管痉挛表现为胸痛,可导致急性冠状动脉综合征、室性心律失常和死亡。虽然大麻仍是滥用最多的精神活性物质,但它与冠状动脉血管痉挛的关系仍不清楚。病例摘要一名 46 岁的女性,有反复心绞痛和吸食大麻的病史,因剧烈胸痛就诊。她突然发生心室颤动,被紧急心脏复律。心电图显示 aVR、V1 和 V2 导联 ST 段抬高,并伴有相互变化。急诊冠状动脉造影显示左冠状动脉主干和左前降支动脉均出现严重痉挛。讨论大麻引起的冠状动脉血管痉挛可归因于儿茶酚胺释放增加导致血管收缩,表现为冠状动脉血管血流量减少,以及心输出量增加导致心肌需氧量增加。心绞痛阈值降低,加上刺激促动脉粥样硬化的 CB1 受体和交感神经活动亢进,进一步增加了急性冠状动脉综合征的风险。需要进一步研究评估大麻对冠状动脉血管的影响。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
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.

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