Arshad Hassaan, Mousa Aliaa, Oudah Bashar, Kakhktsyan Tigran, Abu-Abaa Mohammad, Kass Richard
Internal Medicine Residency Program, Capital Health Regional Medical Center, Trenton, USA.
Internal Medicine, Capital Health Regional Medical Center, Trenton, USA.
Cureus. 2023 May 28;15(5):e39594. doi: 10.7759/cureus.39594. eCollection 2023 May.
Spontaneous coronary artery dissection is a rare and commonly underdiagnosed cause of acute coronary syndrome. Here, we report the case of a 36-year-old male patient who presented with an acute onset of left-sided chest pain, preceded by several hours of nausea and vomiting. Past medical history was significant for chronic marijuana use and multiple episodes of nausea and vomiting requiring multiple hospitalizations. Urinary drug screen was positive for cannabinoids only, and electrocardiography revealed an ST-segment elevation myocardial infarction. This was complicated by an episode of ventricular fibrillation that was successfully defibrillated and prompted cardiac catheterization, which revealed a coronary intraluminal filling defect and a segmental lesion, suggestive of coronary dissection. No evidence of atherosclerotic plaque was noticed. Stent placement and thrombectomy were pursued and the patient was stabilized. As cannabinoid use is gaining legality and becoming widespread, this case aims to enhance physicians' awareness of potentially life-threatening complications of its use.
自发性冠状动脉夹层是急性冠状动脉综合征的一种罕见且常被漏诊的病因。在此，我们报告一例36岁男性患者，该患者突发左侧胸痛，数小时前有恶心和呕吐症状。既往病史有长期使用大麻及多次因恶心和呕吐发作而多次住院。尿液药物筛查仅大麻类物质呈阳性，心电图显示ST段抬高型心肌梗死。该病情因一次心室颤动发作而复杂化，心室颤动成功除颤后促使进行了心脏导管插入术，结果显示冠状动脉腔内充盈缺损和节段性病变，提示冠状动脉夹层。未发现动脉粥样硬化斑块的证据。进行了支架置入和血栓切除术，患者病情稳定。由于大麻类物质的使用正变得合法且广泛，本病例旨在提高医生对其使用可能危及生命的并发症的认识。
