"HIGH AND INFLAMED" A CURIOUS CASE OF CANNABIS-INDUCED RECURRENT MYOPERICARDITIS

Therapeutic Area

CVD Prevention – Primary and Secondary

Case Presentation

A 27-year-old male with a history of presumed viral myopericarditis in 2021 presented with chest pain. He was found to have elevated troponin but coronary angiography was normal. On an echocardiogram, he was found to have a moderately thickened pericardium without effusion and a preserved LV systolic function. He was treated with indomethacin, prednisone, and colchicine however his symptoms recurred in 2023. An electrocardiogram (EKG) showed ST-segment elevation in I and aVL, with mild elevation across septal leads V2-V4. Troponin is 1.86, CPK of 206, and CRP of 5.5. A repeat echocardiogram revealed LVEF 55% Without pericardial effusion and no wall motion abnormalities. The patient clinically improved and was discharged on indomethacin 50 mg q8h to decrease dose by 25 mg per week, colchicine 0.6 mg bid for six weeks, and prednisone 40 mg for weeks with gradual taper.

Background

The United Nations estimated that around 192 million individuals aged 15 to 64 were using cannabis as of 2016(1). Over time, there has been a global trend towards decriminalizing and legalizing recreational cannabis (1). While the immediate impact of cannabis on heart rate is known to occur within 10 to 30 minutes of consumption (2), its long-term effects on cardiovascular health remain less understood due to regulatory constraints (3).

Emerging research suggests a potential connection between prolonged cannabis use and increased risk of cardiovascular diseases, although the precise mechanisms are not fully elucidated (4,5). Conditions like pericarditis and myocarditis, both heart inflammations, share similar symptoms and are diagnosed based on clinical observations, lab tests, and imaging.

Conclusions

Marijuana use has been linked to severe cardiovascular complications, such as myopericarditis. Therefore, healthcare professionals should maintain a high index of suspicion and routinely inquire about marijuana consumption in patients presenting with chest pain. Moreover, there is an apparent demand for further research to ascertain the most efficacious treatment modalities for myopericarditis induced by marijuana usage.