A Case of Stress Cardiomyopathy Linked to Cannabinoid Hyperemesis Syndrome
A 32-year-old woman with cannabinoid hyperemesis syndrome developed takotsubo (stress) cardiomyopathy, suggesting a possible connection between severe cannabis-related vomiting and cardiac complications.
Quick Facts
What This Study Found
A 32-year-old woman presented with severe epigastric pain, nausea, and vomiting after resuming marijuana use following a period of abstinence. Her EKG showed dynamic T-wave changes with modest cardiac biomarker elevation. Imaging revealed the mid-ventricular variant of takotsubo cardiomyopathy with normal coronary arteries.
Her history was consistent with cannabinoid hyperemesis syndrome (CHS): previous episodes of cyclic vomiting relieved by compulsive hot water bathing, with symptoms resolving after marijuana cessation and recurring upon resumption of use.
This was only the second reported case associating takotsubo cardiomyopathy with CHS. The mechanism is not clearly defined, though the authors note that endocannabinoid receptors are expressed in heart muscle tissue, which could represent a pathway for cardiac involvement.
Key Numbers
Patient age: 32 years. EKG showed dynamic T-wave changes. Cardiac biomarkers were modestly elevated. Coronary arteries were normal on angiography. This was the second reported case of takotsubo cardiomyopathy with CHS.
How They Did This
This is a single case report with a literature review. The patient was evaluated with EKG, echocardiography, ventriculography, and cardiac angiography. The diagnosis of takotsubo cardiomyopathy was based on characteristic wall motion abnormalities with normal coronary arteries. CHS was diagnosed based on the clinical pattern of cyclic vomiting with marijuana use.
Why This Research Matters
Cannabinoid hyperemesis syndrome is increasingly recognized as cannabis use becomes more prevalent. This case suggests that severe CHS episodes may carry cardiac risk through stress cardiomyopathy, adding to the known complications of the condition and highlighting the importance of recognizing CHS early.
The Bigger Picture
Takotsubo cardiomyopathy is triggered by intense physical or emotional stress. Severe CHS episodes involve prolonged vomiting, dehydration, and physiological stress that could trigger this cardiac response. As CHS recognition increases, clinicians may need to consider cardiac evaluation in patients presenting with severe episodes.
What This Study Doesn't Tell Us
This is a single case report and cannot establish a causal relationship between CHS and takotsubo cardiomyopathy. The cardiac event may have been coincidental. The mechanism linking the two conditions is speculative. Case reports represent the lowest tier of clinical evidence.
Questions This Raises
- ?Is the association between CHS and takotsubo cardiomyopathy more common than currently recognized?
- ?Does the physiological stress of severe CHS episodes directly trigger cardiac events?
- ?Should patients with severe CHS be screened for cardiac involvement?
Trust & Context
- Key Stat:
- Second reported case of takotsubo cardiomyopathy associated with CHS
- Evidence Grade:
- This is a single case report. It raises awareness of a possible association but cannot establish causation.
- Study Age:
- Published in 2014. Awareness and reporting of both CHS and its potential complications have increased substantially since.
- Original Title:
- Mid-ventricular variant takotsubo cardiomyopathy associated with Cannabinoid Hyperemesis Syndrome: a case report.
- Published In:
- Hawai'i journal of medicine & public health : a journal of Asia Pacific Medicine & Public Health, 73(4), 115-8 (2014)
- Authors:
- Nogi, Masayuki, Fergusson, David(2), Chiaco, John Michael Chua
- Database ID:
- RTHC-00844
Evidence Hierarchy
Describes what happened to one person or a small group.
What do these levels mean? →Frequently Asked Questions
What is takotsubo cardiomyopathy?
Also called "broken heart syndrome" or stress cardiomyopathy, it is a temporary weakening of the heart muscle triggered by intense physical or emotional stress. The heart's shape temporarily changes, and symptoms can mimic a heart attack, but coronary arteries are normal.
What is cannabinoid hyperemesis syndrome?
CHS is a condition in chronic cannabis users characterized by cycles of severe nausea, vomiting, and abdominal pain. A hallmark feature is relief from compulsive hot water bathing. Symptoms resolve when cannabis use stops and return when use resumes.
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Cite This Study
https://rethinkthc.com/research/RTHC-00844APA
Nogi, Masayuki; Fergusson, David; Chiaco, John Michael Chua. (2014). Mid-ventricular variant takotsubo cardiomyopathy associated with Cannabinoid Hyperemesis Syndrome: a case report.. Hawai'i journal of medicine & public health : a journal of Asia Pacific Medicine & Public Health, 73(4), 115-8.
MLA
Nogi, Masayuki, et al. "Mid-ventricular variant takotsubo cardiomyopathy associated with Cannabinoid Hyperemesis Syndrome: a case report.." Hawai'i journal of medicine & public health : a journal of Asia Pacific Medicine & Public Health, 2014.
RethinkTHC
RethinkTHC Research Database. "Mid-ventricular variant takotsubo cardiomyopathy associated ..." RTHC-00844. Retrieved from https://rethinkthc.com/research/nogi-2014-midventricular-variant-takotsubo-cardiomyopathy
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.