Diffuse coronary ectasia and acute coronary syndrome in a young man. Who is guilty? Cannabis, smoking or dyslipidemia?/Genc bir erkekte yaygin koroner ektazi ve akut koroner sendrom. Suclu kim? Esrar, sigara ya da dislipidemi?
Cannabis is produced from flower seeds and dried leaves of the plant "cannabis sativa". Active substance responsible from pharmacologic effects of cannabis is [DELTA]9-tetrahydrocannabinol. Cardiovascular effects of cannabis have been well defined. It increases heart rate (1). It causes supine hypertension, while it may cause upright hypotension (1). In addition to its hemodynamic effects, it significantly disrupts blood's oxygen carrying capacity by increasing carboxyhemoglobin level (2). Cannabis use has also been associated with coronary thrombosis (3). It has also been shown to cause coronary vasospasm (4). All of these effects may lead to myocardial ischemia and infarction (MI) by impairing myocardial oxygen demand-supply balance. Adverse hemodynamic changes may cause rupture of vulnerable coronary plaques. It has been shown that risk of MI increases within one hour after cannabis use (5). However, mechanism of MI following cannabis use is not entirely known. There are many case reports in literature about MI associated with cannabis use. Those cases were young and heavy smokers, like our patient. The main difference of our patient from others in literature was the diffuse ectatic coronaries. Coronary artery ecstasies are commonly associated with atherosclerosis. The main pathogenetic mechanism is thinning of the medial layer of the vessel. This leads to a vicious cycle by causing wall stress. The resulting is progressive dilatation and diffuses ectasia. As we previously mentioned, adverse hemodynamic effects associated with cannabis use may lead to ectasia development by increasing wall stress. We did not find any report in literature reporting cannabis and coronary ectasia association. Our case is the first in this respect. However, one also should take into consideration that he also was a heavy smoker and had dyslipidemia. Nevertheless, in clinical practice, clinicians do not encounter such severely ectatic vessels in young patients no matter how many and severe risk factors such patients have. This fact may suggest contribution of cannabis to development of diffuse ectasia. In conclusion, possible cannabis use should be remembered in young patients having diffuse ectatic coronary arteries with abundant plaques.
Muhammet Rasit Sayin, Ibrahim Akpinar, Mehmet Ali Cetiner , Turgut Karabag
Department of Cardiology, Faculty of Medicine, Bulent Ecevit University, Zonguldak-Turkey
 Clinic of Cardiology, Karadeniz Eregli State Hospital, Zonguldak-Turkey
Video 1. a, b. Left coronary angiogram
Video 2. a, b. Pre-treatment and post-treatment of right coronary angiograms
(1.) Weiss JL, Watanabe AM, Lemberger L, Tamarkin NR, Cardon PV. Cardiovascular effects of delta-9-tetrahydrocannabinol in man. Clin Pharmacol Ther 1972; 13: 671-84.
(2.) Hollister LE. Health aspects of cannabis. Pharmacol Rev 1986; 38: 1-20.
(3.) Tatli E, Yilmaztepe M, Altun G, Altun A. Cannabis-induced coronary artery thrombosis and acute anterior myocardial infarction in a young man. Int J Cardiol 2007; 120: 420-2. [CrossRef]
(4.) Basnet S, Mander G, Nicolas R. Coronary vasospasm in an adolescent resulting from marijuana use. Pediatr Cardiol 2009; 30: 543-5. [CrossRef]
(5.) Mittleman MA, Lewis RA, Maclure M, Sherwood JB, Muller JE. Triggering myocardial infarction by marijuana. Circulation 2001; 103: 2805-9. [CrossRef]
Address for Correspondence/Yazisma Adresi: Dr. Muhammet Rasit Sayin Bulent Ecevit Universitesi Tip Fakultesi, Kardiyoloji Anabilim Dali, Zonguldak-Turkiye
Phone: +90 372 261 21 62
Available Online Date/Cevrimici Yayin Tarihi: 10.09.2013
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|Author:||Sayin, Muhammet Rasit; Akpinar, Ibrahim; Cetiner, Mehmet Ali; Karabag, Turgut|
|Publication:||The Anatolian Journal of Cardiology (Anadolu Kardiyoloji Dergisi)|
|Article Type:||Letter to the editor|
|Date:||Sep 1, 2013|
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