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

Lorenz Räber,Fabien Praz,Sarah Bär

doi:10.1186/s12872-021-01953-3

Lorenz Räber, Fabien Praz

Open Access

https://doi.org/10.1186/s12872-021-01953-3

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Abstract

BackgroundThe 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 presentationThis 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.ConclusionsThis 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.

Highlights

The recreational drugs cannabis and nitrous oxide (N2O) are known for pro-atherogenic effects and are associated with an elevated risk of myocardial infarction
This is the first case to demonstrate the association between cannabis and N 2O abuse and plaque erosion on optical coherence tomography (OCT) in a young man with segment-elevation myocardial infarction (STEMI)
Consumption of cannabis, Nitrous oxide (N2O), and alcohol Chest pain onset Presentation to the emergency department ST-elevation in leads II, III, avF, V4-V6 on initial ECG Coronary angiogram and OCT confirming the diagnosis of STEMI due to plaque erosion in the proximal Left anterior descending artery (LAD) Successful implantation of 1 drug-eluting stent into the LAD Uneventful rhythm monitoring Hospital discharge Good recovery after STEMI, cessation of drug consumption, reduction of smoking, had participated in outpatient cardiac rehabilitation program

Summary

Conclusions

This is the first case to demonstrate the association between cannabis and N 2O 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

Findings

Background

Discussion and conclusions