Clinical Profile of Patients with Synthetic Cannabinoid Receptor Agonist Associated Myocardial Infarction

Background: Synthetic cannabinoid receptor agonists (SCRAs) also knowns as synthetic marijuana comprises a group of compounds that are chemically distinct but act similarly to delta-9-tetrahydrocannabinol (THC), the psychoactive substance in marijuana. SCRAs is the second most commonly abused class of drugs among adolescents. Cardiovascular effects include: tachycardia, hypertension, chest pain and dysrhythmias/conduction abnormalities. Since 2011, multiple myocardial infarction (MI) cases following SM use have been reported from the United States and other countries. Hypothesis: SCRAs related MI portends a unique clinical profile. Methods: A literature search of various databases was conducted using the key words “SCARs, synthetic cannabinoids, synthetic marijuana, myocardial infarction, NSTEMI, STEMI, and coronary artery”. Cited references of the case reports were also reviewed to identify additional cases. Demographic data, electrocardiography (ECG), echocardiography and angiography findings were analyzed. Results: Among 21 published cases, 95% consisted of young men (mean age 25± 11 years). The prevalence of CV risk factors was relatively low. There was a high prevalence of marijuana use among the patients. K2 was the most commonly reported culprit brand (43%). Most patients presented with chest pain (67%), with 40% presented within one hour of SM use. Seventy-nine percent presented with ST-elevations. Echocardiography revealed normal left ventricular wall motion in 71% of patients. Thirty-one percent of the patients who underwent coronary angiography had normal coronaries. Mortality was 5%. Conclusion: SCRAs use should be suspected in young patients presenting with MI including STEMI. A strong index of suspicion is required to identify SCRAs related MI.