Mohammed Denelle
Saint James School of Medicine, Park Ridge, Illinois, United States of America.
Addict Health. 2019 Jul;11(3):202-206. doi: 10.22122/ahj.v11i3.239.
Synthetic cannabinoid use such as "K" and "Spice" is popular due to its inability to be detected in a urine drug screen. It is associated with a wide range of myocardial pathologies including obstructive and non-obstructive coronary disease such as Takotsubo cardiomyopathy.
A case report of an emancipated 15-year-old male experiencing Takotsubo cardiomyopathy after using the synthetic cannabinoid "Spice" is presented here.
Synthetic cannabinoids act as full agonists and bind to cannabinoid receptors (CB receptors) with a much greater potency compared to natural forms of marijuana. In particular, "Spice" decreases the release of glutamate via the CB receptor type 1 (CB1 receptor) in higher concentrations, which causes mitogen-activated protein kinase (MAPK) activation with substances released in response to stressful environments being experienced in the body. These effects can cause the sympathetic system to become activated by synthetic cannabinoid use, leading to a surge in catecholamines and a change from normal positive inotropy to abnormally-mediated negative inotropy. Use of synthetic cannabinoids can therefore be associated with Takotsubo cardiomyopathy. This case has important implications for additional examination due to the sparse information describing co-occurrence of Takotsubo cardiomyopathy and synthetic cannabinoid use.
合成大麻素如“K”和“香料”很受欢迎，因为其在尿液药物筛查中无法被检测到。它与多种心肌病变相关，包括阻塞性和非阻塞性冠状动脉疾病，如应激性心肌病。
本文介绍了一例15岁自主男性在使用合成大麻素“香料”后发生应激性心肌病的病例报告。
合成大麻素作为完全激动剂，与大麻素受体（CB受体）结合的效力比天然形式的大麻要强得多。特别是，“香料”在较高浓度下通过1型CB受体（CB1受体）减少谷氨酸的释放，这会导致丝裂原活化蛋白激酶（MAPK）激活，同时体内因应激环境而释放的物质也会增加。这些效应会导致合成大麻素的使用激活交感神经系统，导致儿茶酚胺激增，并使正常的正性肌力作用转变为异常介导的负性肌力作用。因此，使用合成大麻素可能与应激性心肌病有关。由于描述应激性心肌病与合成大麻素使用同时出现的信息稀少，该病例对进一步检查具有重要意义。
