Baskaran Janani, Anantha Narayanan Mahesh, Vakhshoorzadeh Jasmine, Ahmad Aiza, Bertog Stefan
Internal Medicine, Creighton University, Omaha, USA.
Cardiology, University of Minnesota, Minneapolis, USA.
Cureus. 2019 Jun 1;11(6):e4799. doi: 10.7759/cureus.4799.
Coronary vasospasm is a well-known entity causing acute chest syndrome and can lead to myocardial infarction, ventricular arrhythmias, and even sudden cardiac death. While there are extensive case series showing the association of coronary vasospasm with cocaine, studies reporting marijuana-induced coronary vasospasm are limited in number. We herein present a case of coronary vasospasm in a middle-aged African-American male who presented to the emergency department after an episode of syncope. His urine drug screen was positive only for marijuana. He had a transient elevation of ST segments on his EKG with concomitant wall motion abnormalities on echocardiogram and was later found to have vasospasm of coronary arteries on coronary angiogram without any evidence of focal atherosclerotic disease. Another interesting finding was the persistent inter-coronary communication or coronary arcade connecting the left circumflex artery to the right coronary artery. There was bi-directional flow through the inter-coronary communication and hence, we believe this communication prevented our patient from experiencing acute chest symptoms or myocardial infarction. It is important for the clinicians to recognize the association of marijuana with coronary vasospasm. At the same time, these patients should be treated as acute coronary syndromes until proven otherwise by ischemia evaluation.
冠状动脉痉挛是一种导致急性胸痛综合征的已知病症，可引发心肌梗死、室性心律失常，甚至心源性猝死。虽然有大量病例系列显示冠状动脉痉挛与可卡因有关，但报告大麻诱发冠状动脉痉挛的研究数量有限。我们在此报告一例中年非裔美国男性冠状动脉痉挛病例，该患者在一次晕厥发作后前往急诊科就诊。他的尿液药物筛查仅大麻呈阳性。他的心电图显示ST段短暂抬高，同时超声心动图显示室壁运动异常，后来冠状动脉造影发现冠状动脉痉挛，未发现任何局灶性动脉粥样硬化疾病的证据。另一个有趣的发现是存在持续的冠状动脉间交通或冠状动脉弓，将左旋支动脉与右冠状动脉相连。冠状动脉间交通存在双向血流，因此，我们认为这种交通使我们的患者未出现急性胸痛症状或心肌梗死。临床医生认识到大麻与冠状动脉痉挛的关联很重要。同时，在通过缺血评估排除其他病因之前，这些患者应按急性冠状动脉综合征进行治疗。
