Marijuana-induced Coronary Vasospasm with Persistent Inter-coronary Connection: A Case Report and Review of Literature

Abstract

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.

Keywords: acute myocardial infarction; coronary arcade; coronary circulation; coronary vasospasm; coronary vessel anomalies; marijuana; prinzmetal angina; vasospastic angina.

Figure 1. EKG showing ST-segment elevation in the inferior leads (*arrows point to ST-elevation in the inferior leads)

Figure 2. Repeat EKG showing resolution of ST-segment elevations in the inferior leads

Figure 3. Angiogram images of LAD showing relief of vasospasm post nitroglycerin injection

LAD, left anterior descending artery

Figure 4. Pharmacological stress test showing no evidence of fixed or reversible ischemia