Skip to main content
Key Specialties
Cardiology Diabetology Endocrinology Gastroenterology Geriatrics and Gerontology Gynecology and Obstetrics Hematology Infectious Disease Internal Medicine Nephrology Neurology Oncology Pediatrics Respiratory Medicine Rheumatology Surgery
Congress Coverage
2024 ACC Congress 2023 ESMO Congress 2023 EASD Congress 2023 ERS Congress 2023 ESC Congress 2023 EHA Congress 2023 ASCO Annual Meeting
Clinical Collections
Advances in Alzheimer’s

ACC 2024 Congress

Catch up on all the top stories and latest evidence in cardiology research with our ACC 2024 Congress hub page.
ADVANCED SEARCH
Log in
Top
BMC Cardiovascular Disorders
Published in: BMC Cardiovascular Disorders 1/2021

Open Access 01-12-2021 | ST-Segment Elevation Myocardial Infarction | Case report

Plaque erosion causing ST-elevation myocardial infarction after consumption of cannabis and N2O in a 27-year old man: a case report

Authors: Sarah Bär, Fabien Praz, Lorenz Räber

Published in: BMC Cardiovascular Disorders | Issue 1/2021

Login to get access

Abstract

Background

The recreational drugs cannabis and nitrous oxide (N2O) are known for pro-atherogenic effects and are associated with an elevated risk of myocardial infarction. These cardiovascular effects might be underestimated by the public. Culprit-lesion composition of myocardial infarctions associated with cannabis and N2O has been unknown so far. This case report aims to raise the awareness of the adverse cardiovascular effects of cannabis and N2O and reports, for the first time, optical coherence tomography (OCT) findings of the culprit lesion.

Case presentation

This is a case report of a 27-year old man with anterior ST-segment-elevation myocardial infarction (STEMI) after intoxication with cannabis and N2O. Coronary angiography and OCT revealed plaque erosion with subsequent subtotal thrombotic occlusion of the left anterior descending artery that was successfully treated with 1 drug-eluting stent. The patient was symptom free at 6 months follow-up and had been able to abstain from drug consumption.

Conclusions

This is the first case to demonstrate the association between cannabis and N2O abuse and plaque erosion on OCT in a young man with STEMI. In contrast to smoking, whose adverse effects are well-known, the cardiovascular effects of cannabis and N2O might be underestimated. These adverse effects should gain more awareness in the public to prevent early vascular events in young adults.
Appendix
Available only for authorised users
Literature
1.
van Amsterdam J, Nabben T, van den Brink W. Recreational nitrous oxide use: prevalence and risks. Regul Toxicol Pharmacol. 2015;73:790–6.CrossRef
2.
Tiyerili V, Zimmer S, Jung S, Wassmann K, Naehle CP, Lütjohann D, et al. CB1 receptor inhibition leads to decreased vascular AT1 receptor expression, inhibition of oxidative stress and improved endothelial function. Basic Res Cardiol. 2010;105:465–77.CrossRef
3.
Jiang L, Pu J, Han Z, Hu L, He B. Role of activated endocannabinoid system in regulation of cellular cholesterol metabolism in macrophages. Cardiovasc Res. 2009;81:805–13.CrossRef
4.
Badner NH, Beattie WS, Freeman D, Spence JD. Nitrous oxide-induced increased homocysteine concentrations are associated with increased postoperative myocardial ischemia in patients undergoing carotid endarterectomy. Anesth Analg. 2000;91:1073–9.PubMed
5.
Leslie K, Myles PS, Chan MTV, Forbes A, Paech MJ, Peyton P, et al. Nitrous oxide and long-term morbidity and mortality in the ENIGMA trial. Anesth Analg. 2011;112:387–93.CrossRef
6.
Mittleman MA, Lewis RA, Maclure M, Sherwood JB, Muller JE. Triggering myocardial infarction by marijuana. Circulation. 2001;103:2805–9.CrossRef
7.
Partida RA, Libby P, Crea F, Jang I-K. Plaque erosion: a new in vivo diagnosis and a potential major shift in the management of patients with acute coronary syndromes. Eur Heart J. 2018;39:2070–6.CrossRef
8.
Ibanez B, James S, Agewall S, Antunes MJ, Bucciarelli-Ducci C, Bueno H, et al. 2017 ESC Guidelines for the management of acute myocardial infarction in patients presenting with ST-segment elevation. Eur Heart J. 2018;39:119–77.CrossRef
9.
Pushpakumar S, Kundu S, Sen U. Endothelial dysfunction: the link between homocysteine and hydrogen sulfide. Curr Med Chem. 2014;21:3662–72.CrossRef
10.
Indraratna P, Alexopoulos C, Celermajer D, Alford K. Acute ST-elevation myocardial infarction, a unique complication of recreational nitrous oxide use. Heart Lung Circ. 2017;26:e41–3.CrossRef
11.
Bhakta N, Liu Q, Yeo F, Baassiri M, Ehrhardt MJ, Srivastava DK, et al. Cumulative burden of cardiovascular morbidity in paediatric, adolescent, and young adult survivors of Hodgkin’s lymphoma: an analysis from the St Jude Lifetime Cohort Study. Lancet Oncol. 2016;17:1325–34.CrossRef
12.
Montone RA, Vetrugno V, Camilli M, Russo M, Fracassi F, Khan SQ, et al. Macrophage infiltrates in coronary plaque erosion and cardiovascular outcome in patients with acute coronary syndrome. Atherosclerosis. 2020;311:158–66.CrossRef
13.
Xing L, Yamamoto E, Sugiyama T, Jia H, Ma L, Hu S, et al. EROSION Study (effective anti-thrombotic therapy without stenting: intravascular optical coherence tomography-based management in plaque erosion): a 1-year follow-up report. Circ Cardiovasc Interv. 2017;10:e005860.CrossRef
14.
Johnson TW, Räber L, de Mario C, Bourantas C, Jia H, Mattesini A, et al. Clinical use of intracoronary imaging. Part 2: acute coronary syndromes, ambiguous coronary angiography findings, and guiding interventional decision-making: an expert consensus document of the European Association of Percutaneous Cardiovascular Interventions. Eur Heart J. 2019;40:2566–84.CrossRef
Metadata
Title
Plaque erosion causing ST-elevation myocardial infarction after consumption of cannabis and N2O in a 27-year old man: a case report
Authors
Sarah Bär
Fabien Praz
Lorenz Räber
Publication date
01-12-2021
Publisher
BioMed Central
Published in
BMC Cardiovascular Disorders / Issue 1/2021
Electronic ISSN: 1471-2261
DOI
https://doi.org/10.1186/s12872-021-01953-3

Other articles of this Issue 1/2021

BMC Cardiovascular Disorders 1/2021 Go to the issue

Research article

Impact of hospital volume on clinical outcomes of hospitalized heart failure patients: analysis of a nationwide database including 447,818 patients with heart failure

Research article

Burden of oral anticoagulation in embolic stroke of undetermined source without atrial fibrillation

Research article

The 10-year incidence of hypertension across blood pressure categories in a population-based cohort in southwestern Sweden

Research

Bone marrow-derived mesenchymal stem cells attenuate myocardial ischemia–reperfusion injury via upregulation of splenic regulatory T cells

Research article

Direct comparison of multilayer left ventricular global longitudinal strain using CMR feature tracking and speckle tracking echocardiography

Research article

The prognostic value of MELD-XI in elderly patients with ST-segment elevation myocardial infarction: an observational study

ACC 2024 Congress Coverage

Cardiology Video

Highlights from the ACC 2024 Congress

Watch now

Watch official videos from the ACC congress summarizing key highlights from the last year in heart failure, cardiomyopathies, valvular disease, pulmonary vascular disease, and pediatric cardiology.

Semaglutide benefits people with type 2 diabetes and obesity-related heart failure

16-04-2024 Type 2 Diabetes News

Incentivised to exercise

11-04-2024 Lifestyle Modifications News

New intervention for STEMI-related cardiogenic shock

10-04-2024 Myocardial Infarction News

» View more highlights on the ACC 2024 congress hub page

Image Credits