A Case of Stress Cardiomyopathy Linked to Cannabinoid Hyperemesis Syndrome | Research

The takeaway

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.

Read this if you want to understand potential cardiac complications of cannabinoid hyperemesis syndrome.

Second reported case of takotsubo cardiomyopathy associated with CHS

What the researchers 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.

Why it 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 numbers in context

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 the study worked

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.

What this study cannot 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.

How to read the evidence

This is a single case report. It raises awareness of a possible association but cannot establish causation.

When this study was published

Published in 2014. Awareness and reporting of both CHS and its potential complications have increased substantially since.

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.

Questions still open

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?

Common 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.

Read the original research

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

View on PubMed ↗

Citation

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.