Coronary vasospasm complicating cannabinoid hyperemesis syndrome

Abstract

Cannabinoid hyperemesis syndrome (CHS) is a clinical condition that was first described in 2004. The syndrome may occasionally be observed in long-term cannabis users and is characterized by a set of features: severe cyclic nausea and vomiting, recurrent epigastric or periumbilical pain, relief of symptoms with hot baths, and cannabis use cessation. The pathophysiology is not fully understood but is probably related to Cannabinoid-1 (CB-1) receptors dysregulation. On the other hand, there is also growing epidemiological evidence that cannabis smoking may trigger acute coronary syndrome (ACS) in young men. We describe the case of 41-year-old man with a long history of cannabis smoking who not only complained of recurrent epigastric but also of retrosternal pain. He had undergone several negative radiological or endoscopic investigations. During the last episode, electrocardiographic and echocardiographic changes were consistent with takotsubo cardiomyopathy. However, the patient was readmitted very soon with a ST-elevation myocardial infarction related to coronary vasospasm. While the link between CHS and ACS is not established, CHS patients with atypical pain should be investigated carefully to exclude any serious cardiac event.<Learning objective: Cannabinoid hyperemesis syndrome is a rare medical entity than can be observed in some long-term heavy cannabis users. While most patients usually complain of recurrent epigastric or periumbilical pain with negative investigations, the possibility of some serious cardiac event should not be neglected as cannabis seems also able to trigger coronary vasospasm in patients presenting with atypical pain or electrocardiographic changes.>