Coronary Vasospasm Associated With Synthetic Marijuana Resulting in Transient Electrocardiogram Changes and Troponin Elevation

Abstract

Chest pain is a common presentation in the emergency department requiring prompt evaluation and risk stratification to assess for acute coronary syndrome versus non-cardiac causes. In the past, cocaine has been documented to be associated with the presentation of acute myocardial infarction. This case report describes a rare case of coronary vasospasm with transient electrocardiogram (EKG) changes and significantly elevated troponin in an individual presenting with a recent history of synthetic marijuana use. This report highlights the initial presentation, progression, and management of synthetic marijuana-associated coronary vasospasm mimicking the presentation of acute myocardial infarction. This is a unique case that describes not only the clinical presentation with dynamic EKG changes but also significantly elevated biomarkers, as would be seen with acute myocardial infarction. Challenges associated with synthetic marijuana-mediated coronary vasospasm are not only related to the management but also present a diagnostic challenge because it is not easily detected by urinary drug screen compared to traditional marijuana.

Keywords: acute coronary syndrome; chest pain; ekg; marijuana; myocardial infarction; st elevation; transient; vasospasm.

Figure 1. EKG showing ST elevation.

Initial EKG showing isolated ST elevation pointed by the horizontal arrow and T-wave inversions in multiple leads indicated by the diagonal arrows. EKG: electrocardiogram

Figure 2. Repeat EKG.

No ST elevation noted or T-wave inversion in III aVF or other leads. EKG: electrocardiogram