Recurrent Cardiogenic Shock Associated with Cannabis Use: Report of a Case and Review of the Literature



      The United States has recently undergone increases in the legalization and use of marijuana. There have been previous reports on the association of cannabis use and myocardial dysfunction, however, few on the association with acute stress cardiomyopathy and cardiogenic shock.

      Case Report

      This is a case of a 58-year-old female with a history of inhaled cannabis use, no history of diabetes, and no known history of cardiac disease, that illustrates an association between cannabis use and the recurrent development of stress cardiomyopathy and cardiogenic shock. A review of medical records was performed from two hospitalizations and subsequent outpatient follow-up for similar presentations 6 years apart and review of literature regarding cannabis use and its association with cardiac dysfunction. In separate hospitalizations, the patient presented with clinical findings of cardiogenic shock, severe left ventricular dysfunction with morphologic features of stress cardiomyopathy, and normal coronary angiography. Laboratory results included elevated cardiac biomarkers and urine tetrahydrocannabinol levels > 300 ng/mL. The patient required intensive cardiovascular support, but recovered with normal cardiac function after each event.

      Why Should an Emergency Physician Be Aware of This?

      As use of cannabis becomes more prevalent, it will be important for physicians to recognize the potential association of cannabis use and acute myocardial dysfunction, and how early treatment may contribute to salutary outcomes.


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        • Azofeifa A.
        • Mattson M.E.
        • Grant A.
        Monitoring marijuana use in the United States: challenges in an evolving environment.
        JAMA. 2016; 316: 1765-1766
        • Kaushik M.
        • Alla V.M.
        • Madan R.
        • Arouni A.J.
        • Mohiuddin S.M.
        Recurrent stress cardiomyopathy with variable regional involvement.
        Circulation. 2011; 124: e556-e557
        • Vandevenne M.
        • Vandenbussche H.
        • Verstraete A.
        Detection time of drugs of abuse in urine.
        Acta Clin Belg. 2000; 55: 323-333
        • Allen J.H.
        • de Moore G.M.
        • Heddle R.
        • Twartz J.C.
        Cannabinoid hyperemesis: cyclical hyperemesis in association with chronic cannabis abuse.
        Gut. 2004; 53: 1566-1570
        • Scally C.
        • Rudd A.
        • Mezincescu A.
        • et al.
        Persistent long-term structural, functional, and metabolic changes after stress-induced (Takotsubo) cardiomyopathy.
        Circulation. 2018; 137: 1039-1048
        • Sharkey S.W.
        • Lesser J.R.
        • Maron B.J.
        Takotsubo (stress) cardiomyopathy.
        Circulation. 2011; 124: e460-e462
        • Nogi M.
        • Fergusson D.
        • Chiaco J.M.
        Mid-ventricular variant Takotsubo cardiomyopathy associated with cannabinoid hyperemesis syndrome: a case report.
        Hawaii J Med Public Health. 2014; 73: 115-118
        • Pacher P.
        • Steffens S.
        • Haskó G.
        • Schindler T.H.
        • Kunos G.
        Cardiovascular effects of marijuana and synthetic cannabinoids: the good, the bad, and the ugly.
        Nat Rev Cardiol. 2018; 15: 151-166
        • Villablanca P.A.
        • Sukhal S.
        • Ansari A.
        • Mohammed D.
        Acute gastritis-induced Takotsubo’s cardiomyopathy.
        Clin Case Rep. 2013; 1: 91-95
        • Bonz A.
        • Laser M.
        • Küllmer S.
        • et al.
        Cannabinoids acting on CB1 receptors decrease contractile performance in human atrial muscle.
        J Cardiovasc Pharmacol. 2003; 41: 657-664
        • Pacher P.
        • Bátkai S.
        • Kunos G.
        Cardiovascular pharmacology of cannabinoids.
        Handb Exp Pharmacol. 2005; 168: 599-625
        • Bátkai S.
        • Pacher P.
        Endocannabinoids and cardiac contractile function: pathophysiological implications.
        Pharmacol Res. 2009; 60: 99-106
        • Grotenhermen F.
        Pharmacokinetics and pharmacodynamics of cannabinoids.
        Clin Pharmacokinet. 2003; 42: 327-360
        • Dembitsky W.P.
        • Moore C.H.
        • Holman W.L.
        • et al.
        Successful mechanical circulatory support for noncoronary shock.
        J Heart Lung Transplant. 1992; 11: 129-135