Cannabis Use and Premature Atherosclerosis: An ED Risk Factor To Ask About?
Emergency Cardiology Literature Review & Updates with Dr. Amal Mattu
HPI
A 36-year-old man with hypertension and regular cannabis use (edibles, ~3x/week) is referred from clinic to the ED for chest pain and an abnormal ECG. His first ECG during pain is read as an anterolateral STEMI and is shown below:
After aspirin and nitroglycerin his pain resolves and a second ECG no longer meets STEMI criteria but looks different. Twelve minutes later a third pain-free ECG again triggers a another machine STEMI alert. Cardiology interprets the tracings as evolving changes and takes him to the cath lab. Here is a limb lead comparison of the 3 serial ECGs obtained:
Before watching this week’s workout, review these ECGs and consider:
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- Why do ECGs 1 and 2 look so different despite symptom improvement, and what common limb-lead mix-up could explain it?
- What do we now know about cannabis use as a cardiovascular risk factor, even in young patients using edibles?
- Do you think this patient was ultimately found to have an acute MI?
