Dataset Information

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

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.

SUBMITTER: Bar S

PROVIDER: S-EPMC7988925 | biostudies-literature | 2021 Mar

REPOSITORIES: biostudies-literature

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Publications

Plaque erosion causing ST-elevation myocardial infarction after consumption of cannabis and N<sub>2</sub>O in a 27-year old man: a case report.

Bär Sarah S Praz Fabien F Räber Lorenz L

BMC cardiovascular disorders 20210323 1

<h4>Background</h4>The recreational drugs cannabis and nitrous oxide (N<sub>2</sub>O) 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 N<sub>2</sub>O has been unknown so far. This case report aims to raise the awareness of the adverse cardiovascular effects of cannabis and N<sub>2</sub>O and r ...[more]

PMID: 33757456

Similar Datasets

Project description:BackgroundTreating acute myocardial infarction in the setting of insignificant coronary obstruction is an emerging challenge especially with the application of intracoronary imaging like intravascular ultrasound and optical coherence tomography (OCT). The cardiologists dealing with such patients may consider not to stent if there is intracoronary imaging evidence of minimal thrombus without plaque rupture and the vessel appears patent with settling of chest pain and electrocardiogram (ECG) changes.Case summaryA 47-year-old gentleman presented direct to the emergency department after experiencing retrosternal chest pain with an ECG showing hyperacute anterior T waves. He had ongoing chest pain and was therefore brought to the cardiac cath lab on the primary percutaneous coronary intervention (PCI) pathway. The first picture showed that the proximal left anterior descending (LAD) was occluded (TIMI 0 flow) with evidence of large thrombus burden. Pre-dilating with a 2.5 × 15 mm balloon did not change flow. Aspiration with an Export catheter was carried out for several runs. Most of the thrombus was successfully removed; however, some of it did go into the distal LAD but was successfully retrieved with aspiration catheter. The diagonal branch was occluded with thrombus which was wired followed by thrombus aspiration establishing TIMI II flow. The procedure was covered with Eptifibatide boluses and heparin. After thrombectomy, angiographically there was no obvious lesion present within the LAD. Optical coherence tomography confirmed only mild atheroma with a small amount of plaque and minimal thrombus. There was OCT evidence of plaque erosion without any plaque rupture. The area was above 9 mm2 and we decided not to treat that with a stent. The right coronary artery had an anterior take-off and was unobstructed. In conclusion, the patient had successful primary PCI to LAD with thrombus aspiration and balloon angioplasty only. He was placed on 12 months of dual antiplatelets therapy with Aspirin and Prasugrel.DiscussionThis case highlights the rare presentation of patients with acute myocardial infarction with plaque erosion and the usefulness of OCT in formulating a management plan.

Project description:BackgroundPercutaneous coronary intervention with placement of a drug-eluting stent in a diabetic patient with ST-elevation myocardial infarction is a relatively common procedure, and always requires subsequent treatment with dual antiplatelet therapy. It is sometimes necessary to add oral anticoagulation therapy because of individual clinical circumstances, which further increases the risk of bleeding.Case presentationA 66-year-old hypertensive diabetic man with a history of gastrointestinal bleeding was admitted with an ST-elevation inferior myocardial infarction that had been evolving over 72 h. Electrocardiography showed ST segment elevation in the inferior leads and Q waves in the inferior and anterior leads. He reported a similar episode of chest pain 1 month previously, for which he had not sought medical treatment. Coronary angiography showed chronic occlusion of the mid-left anterior descending coronary artery, and acute occlusion of the mid-right coronary artery. He was treated by percutaneous coronary intervention, with placement of a drug-eluting stent in the right coronary artery. Soon after admission, transthoracic echocardiography showed abnormal left ventricular contractility and a large left intraventricular thrombus. Three weeks after admission, the patient was discharged on dual antiplatelet therapy (clopidogrel and aspirin) and oral anticoagulation therapy (acenocoumarol). Four months after discharge, transthoracic echocardiography showed absence of left ventricular thrombus and resolution of the abnormal contractility in the area supplied by the revascularized right coronary artery. Given the high risk of bleeding, oral anticoagulation therapy was stopped. Six months later, transthoracic echocardiography showed recurrent left ventricular apical thrombus, and an underlying hypercoagulable state was ruled out. Oral anticoagulation therapy was restarted on an indefinite basis, and dual antiplatelet therapy was continued.ConclusionsThe present case illustrates the need for repeat transthoracic echocardiography following the withdrawal of oral anticoagulation therapy in patients with ST-elevation myocardial infarction, both to monitor thrombus status and to assess left ventricular segmental contraction. In patients who require anticoagulation, avoidance of a drug-eluting stent is strongly preferred and second-generation stents are recommended. The alternative regimen of oral anticoagulation and clopidogrel may be considered in this scenario. In patients with recurrent intraventricular thrombus an underlying hypercoagulable state should be ruled out.

Dataset Information

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

Background

Case presentation

Conclusions

Publications

Plaque erosion causing ST-elevation myocardial infarction after consumption of cannabis and N<sub>2</sub>O in a 27-year old man: a case report.

Similar Datasets

OmicsDI is part of the ELIXIR infrastructure

Tweets

Dataset Information

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

Background

Case presentation

Conclusions

Publications

Plaque erosion causing ST-elevation myocardial infarction after consumption of cannabis and N<sub>2</sub>O in a 27-year old man: a case report.

Similar Datasets

OmicsDI is part of the ELIXIR infrastructure

Tweets

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