Sanchez Alexandra M, Sennhauser Susie, Lozier Matthew R, Purow Joshua M
Internal Medicine, Holy Cross Hospital/ University of Miami, Fort Lauderdale, USA.
Cardiology, Mayo Clinic Jacksonville, Jacksonville, USA.
Cureus. 2019 Oct 24;11(10):e5987. doi: 10.7759/cureus.5987.
Takotsubo cardiomyopathy (TTC) is prevalent in 2% of patients who present with symptoms suggestive of acute myocardial infarction. It may be triggered by stressful events, resulting in catecholamine surges, myocardial stunning, and disturbances in contractility. TTC in males has been associated with marijuana use and leads to a fivefold increased risk of cardiac events. Marijuana is thought to generate a similar surge in catecholamines leading to tachycardia and elevation of both systolic and diastolic blood pressure. The question remains whether this catecholamine surge is sufficient enough to cause TTC. It is apparent a correlation between marijuana use and TTC may exist. Exogenous cannabinoid stimulation may lead to myocardial stunning via stimulation seen with hypercatecholaminergic states. Understanding the risk factors involved and increasing awareness of cardiovascular complications related to cannabinoid substances becomes more relevant as its use is increasing both recreationally and medically. We present a case of a 50 year-old African-American male with hypertension and regular marijuana use who presented with chest pain radiating to the back. Due to abnormal electrocardiogram and positive cardiac biomarkers concerning for acute coronary syndrome, the patient underwent subsequent coronary angiography that showed no significant coronary obstruction; however, left ventriculogram showed the characteristic apical ballooning of TTC. Our case highlights the pathophysiological mechanism suspected to trigger TTC.
应激性心肌病（TTC）在出现急性心肌梗死症状的患者中占比2%。它可能由应激事件引发，导致儿茶酚胺激增、心肌顿抑和收缩功能紊乱。男性TTC与吸食大麻有关，会使心脏事件风险增加五倍。大麻被认为会引发类似的儿茶酚胺激增，导致心动过速以及收缩压和舒张压升高。问题在于这种儿茶酚胺激增是否足以引发TTC。显然，吸食大麻与TTC之间可能存在关联。外源性大麻素刺激可能通过与高儿茶酚胺能状态所见类似的刺激导致心肌顿抑。随着大麻在娱乐和医疗方面的使用不断增加，了解其中涉及的风险因素并提高对与大麻素物质相关的心血管并发症的认识变得愈发重要。我们报告一例50岁患有高血压且经常吸食大麻的非裔美国男性病例，该患者出现放射至背部的胸痛。由于心电图异常且心脏生物标志物呈阳性，提示急性冠状动脉综合征，患者随后接受冠状动脉造影，结果显示无明显冠状动脉阻塞；然而，左心室造影显示出TTC特征性的心尖部气球样改变。我们的病例突出了疑似引发TTC的病理生理机制。
