Oomens Thomas, Riezebos Robert K, Amoroso Giovanni, Kuipers Remko S
Department of Cardiology, OLVG, Oosterpark 9, 1091 AC Amsterdam, The Netherlands.
Eur Heart J Case Rep. 2021 Jan 12;5(2):ytaa557. doi: 10.1093/ehjcr/ytaa557. eCollection 2021 Feb.
Nitrous oxide (NO, laughing gas) is increasingly used as a recreational drug and is presumed relatively safe and innocent. It is often being used in combination with other substances, such as cannabis.
A young adult attended the emergency room because of chest pain after recreational use of very high-dose nitrous oxide in combination with cannabis. Electrocardiography demonstrated ST-elevation in the anterior leads. Coronary angiography showed thrombus in the proximal and thrombotic occlusion of the distal left anterior descending coronary artery for which primary percutaneous coronary intervention was attempted. Thrombus aspiration was unsuccessful and the patient was further treated with a glycoprotein IIb/IIIa in addition to dual platelet therapy. Blood results showed low vitamin B12 and folic acid status with concomitant hyperhomocysteinaemia, a known cause of hypercoagulation. Transthoracic echocardiogram showed a moderately reduced left ventricular ejection fraction (LVEF). Three months later, an improvement in LVEF and no recurrent angina or symptoms of heart failure were noticed.
We report a case of acute myocardial infarction secondary to very high-dose nitrous oxide abuse in combination with cannabis and possible hypoxia. We propose that severe hyperhomocysteinaemia secondary to nitrous oxide-induced vitamin B12 deficiency together with the vasoconstrictive effects of cannabis might pose a seriously increased risk for intracoronary, among others, thrombus formation. In conclusion, we contest the safety and innocence of recreational nitrous oxide (ab)use, notably in the context of other factors increasing the risk of coagulation.
一氧化二氮（NO，笑气）越来越多地被用作消遣性毒品，人们认为它相对安全无害。它经常与其他物质，如大麻一起使用。
一名年轻人在消遣性使用高剂量一氧化二氮并同时吸食大麻后因胸痛前往急诊室。心电图显示前壁导联ST段抬高。冠状动脉造影显示左前降支近端有血栓，远端血栓性闭塞，为此尝试进行了直接经皮冠状动脉介入治疗。血栓抽吸未成功，除双联抗血小板治疗外，患者还接受了糖蛋白IIb/IIIa治疗。血液检查结果显示维生素B12和叶酸水平低，同时伴有高同型半胱氨酸血症，这是已知的高凝原因。经胸超声心动图显示左心室射血分数（LVEF）中度降低。三个月后，LVEF有所改善，未再发心绞痛或出现心力衰竭症状。
我们报告了一例因高剂量一氧化二氮滥用并同时吸食大麻及可能存在缺氧导致的急性心肌梗死病例。我们认为，一氧化二氮诱导的维生素B12缺乏继发的严重高同型半胱氨酸血症，以及大麻的血管收缩作用，可能会显著增加冠状动脉内血栓形成等风险。总之，我们对消遣性一氧化二氮（滥）用的安全性和无害性提出质疑，特别是在存在其他增加凝血风险因素的情况下。
