Cannabis induced myocardial infarction underlying mechanism and the place of glycoprotein IIb/IIIa inhibitors in its management: Two illustrative cases of acute anterior myocardial infarction related to cannabis

Cannabis is known to have been used for medicinal purposes and recreational use to increase sociability and produce euphoria. Regular use of cannabis can have adverse effects. Cardiovascular effects are not associated with serious health problems, although occasional myocardial infarction, stroke, and other adverse cardiovascular events are described. Indeed, there is insufficient knowledge concerning acute myocardial infarction (AMI) associated with cannabis and its underlying mechanism. We reported two illustrative cases of acute anterior myocardial infarction caused by cannabis abuse to emphasize on it as the most probable causes of AMI observed in apparently healthy young persons who use this drug. Introduction Cannabis is known to have been used for medicinal purposes and recreational use to increase sociability and produce euphoria for thousands of years [1]. Over the past 50 years, it has been increasingly adopted by adolescents and young adults in high-income countries, and has recently become popular on a global scale. Regular use of cannabis during adolescence and into adulthood can have adverse effects. Cardiovascular effects are not associated with serious health problems for most young healthy users, although occasional myocardial infarction, stroke, and other adverse cardiovascular events are described. Indeed, there is insufficient knowledge concerning acute myocardial infarction (AMI) associated with cannabis and its underlying mechanism. We reported two illustrative cases of acute anterior myocardial infarction caused by cannabis abuse to emphasize on it as the most probable causes of AMI observed in apparently healthy young persons who use this drug. Case 1 A 22 year old man with a family history of coronary artery disease was admitted with tight central chest pain, one month after donating a kidney for his brother. Physical examination was unremarkable. The admission electrocardiogram showed ST segment elevation in anterior leads. The patient was not taking any medications. Later on, it was determined that he had been smoking cannabis; in addition, he smoked 10-15 tobacco cigarettes per day. He was taken immediately to the coronary angiography laboratory for PCI. On coronary angiogram, it was observed that he had an extensive spontaneous coronary artery dissection of the proximal segment of left anterior descending (LAD) artery with a total occlusion of its distal segment (Figure 1). Intravascular Ultrasound examination demonstrated a dissection flap (Figure 2). We managed the patient conservatively using Glycoprotein IIb/IIIa inhibitors (Tirofiban). The peak cardiac troponine I was 9 μg/L and echocardiography revealed left ventricular septal and apical wall motion abnormalities and a ventricular thrombus located at the apex of the left ventricle was present. After one week, the angiographic control showed complete disappearance of the dissection. The clinical course was uneventful and the patient was discharged. Case 2 A 37-year-old man with no relevant risk factors for coronary artery Correspondence to: Aymen Noamen, MD, Cardiology Department, Military Hospital of Tunis, Tunisia; Tel: +21692661992; E-mail: no.aymen@gmail.com