A patient who smoked PCP-laced cannabis developed ECG changes mimicking a dangerous heart condition
A case report described a patient who presented with chest pain and electrocardiogram changes resembling Wellens' syndrome (which signals critical coronary artery blockage) after smoking phencyclidine-laced cannabis, but coronary angiography showed no actual artery disease.
Quick Facts
What This Study Found
A patient arrived with atypical left chest pain and dizziness that started 6 hours after smoking phencyclidine (PCP)-laced cannabis.
The ECG showed new deep biphasic T-wave inversions in anterolateral leads, a pattern characteristic of Wellens' syndrome, which typically indicates critical blockage of the left anterior descending artery and imminent heart attack risk.
However, troponin levels were normal and coronary angiography revealed no coronary artery disease. The ECG changes resolved as the chest pain subsided, consistent with a drug-induced mimic rather than true coronary pathology.
The authors diagnosed pseudo-Wellens' syndrome caused by acute PCP and cannabis intoxication.
Key Numbers
Troponin T levels were normal. ECG showed sinus rhythm with new deep biphasic T-wave inversions in anterolateral leads. Coronary angiography showed no pathological processes. Symptoms and ECG changes resolved within 6 hours of onset.
How They Did This
Single case report with ECG documentation, cardiac biomarker testing (troponin T), and coronary angiography to rule out true coronary artery disease.
Why This Research Matters
Emergency physicians encountering Wellens' syndrome ECG patterns need to consider drug intoxication as a cause, particularly in younger patients. Misdiagnosis could lead to unnecessary invasive cardiac procedures, while missing true Wellens' syndrome could be fatal.
The Bigger Picture
This adds to a small but growing literature on cardiovascular effects of combined substance use. Cannabis alone has been associated with acute cardiovascular events, but the combination with PCP (which has its own sympathomimetic effects) may create distinct cardiac presentations that clinicians should recognize.
What This Study Doesn't Tell Us
Single case report, so the findings cannot be generalized. The cannabis was laced with PCP, making it impossible to separate the cardiac effects of each substance. No follow-up data on whether the patient experienced recurrent episodes.
Questions This Raises
- ?Can cannabis alone cause pseudo-Wellens' ECG patterns, or was PCP the primary driver?
- ?How common are cardiac ECG mimics in emergency departments among patients presenting after cannabis use?
Trust & Context
- Key Stat:
- ECG changes mimicking imminent heart attack resolved once drug effects wore off
- Evidence Grade:
- Preliminary. Single case report without controls or broader population data.
- Study Age:
- Published in 2018. Pseudo-Wellens' syndrome remains an uncommon but recognized diagnostic consideration.
- Original Title:
- Pseudo-Wellens' syndrome secondary to concurrent cannabis and phencyclidine intoxication.
- Published In:
- BMJ case reports, 2018 (2018)
- Authors:
- Inayat, Faisal(2), Riaz, Iqra, Ali, Nouman Safdar, Figueredo, Vincent M
- Database ID:
- RTHC-01700
Evidence Hierarchy
Describes what happened to one person or a small group.
What do these levels mean? →Frequently Asked Questions
What is Wellens' syndrome?
Wellens' syndrome is a specific ECG pattern (deep T-wave inversions in certain leads) that signals critical blockage of the left anterior descending coronary artery. It's considered a medical emergency because it indicates high risk of a major heart attack.
Was this caused by the cannabis or the PCP?
It is not possible to determine from this case. The cannabis was laced with PCP, and both substances have cardiovascular effects. PCP is a potent sympathomimetic that can raise blood pressure and heart rate significantly.
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Cite This Study
https://rethinkthc.com/research/RTHC-01700APA
Inayat, Faisal; Riaz, Iqra; Ali, Nouman Safdar; Figueredo, Vincent M. (2018). Pseudo-Wellens' syndrome secondary to concurrent cannabis and phencyclidine intoxication.. BMJ case reports, 2018. https://doi.org/10.1136/bcr-2018-225755
MLA
Inayat, Faisal, et al. "Pseudo-Wellens' syndrome secondary to concurrent cannabis and phencyclidine intoxication.." BMJ case reports, 2018. https://doi.org/10.1136/bcr-2018-225755
RethinkTHC
RethinkTHC Research Database. "Pseudo-Wellens' syndrome secondary to concurrent cannabis an..." RTHC-01700. Retrieved from https://rethinkthc.com/research/inayat-2018-pseudowellens-syndrome-secondary-to
Access the Original Study
Study data sourced from PubMed, a service of the U.S. National Library of Medicine, National Institutes of Health.
This study breakdown was produced by the RethinkTHC research team. We analyze and report published research findings without making health recommendations. All interpretations are based solely on the published abstract and study data.