A Long-Term Cannabis User Developed Coronary Vasospasm Alongside Cannabinoid Hyperemesis Syndrome | Research

The takeaway

A 41-year-old chronic cannabis smoker with cannabinoid hyperemesis syndrome also developed coronary vasospasm causing a heart attack, suggesting CHS patients with atypical chest pain should be evaluated for cardiac events.

Heavy cannabis users experiencing unexplained chest pain along with nausea and vomiting.

STEMI from coronary vasospasm in a 41-year-old chronic cannabis user with CHS

What the researchers found

A 41-year-old man with a long history of cannabis smoking presented with recurrent episodes of epigastric and retrosternal (chest) pain. He had undergone multiple negative gastrointestinal investigations over time.

During one hospitalization, ECG and echocardiographic changes were consistent with takotsubo cardiomyopathy (stress cardiomyopathy). Shortly after, he was readmitted with a ST-elevation myocardial infarction (STEMI) caused by coronary vasospasm, confirmed on cardiac catheterization.

The case raises the concern that cannabinoid hyperemesis syndrome (CHS), which typically presents with abdominal pain, may also involve cardiac complications. While a direct causal link between CHS and acute coronary syndrome has not been established, there is growing epidemiological evidence that cannabis smoking can trigger coronary vasospasm in young adults.

Why it matters

This case highlights that chest pain in CHS patients should not be automatically attributed to the gastrointestinal syndrome. Cannabis has independent cardiovascular effects including potential for coronary vasospasm, and CHS patients may be at particular risk because their recurrent presentations lead clinicians to attribute all symptoms to the known condition.

The numbers in context

Patient age: 41. Takotsubo cardiomyopathy identified on echocardiography. STEMI caused by coronary vasospasm confirmed on catheterization.

How the study worked

Single case report with clinical history, ECG findings, echocardiography, and cardiac catheterization results.

What this study cannot tell us

Single case report cannot establish causation between cannabis use and the cardiac events. The patient's cardiovascular risk factors beyond cannabis use were not detailed in the abstract. Takotsubo cardiomyopathy and coronary vasospasm can occur without cannabis use.

How to read the evidence

Preliminary evidence from a single case report. Cannot establish causation.

When this study was published

Published in 2017. Awareness of both CHS and cannabis-related cardiovascular events has increased since.

The bigger picture

This case sits at the intersection of two increasingly recognized cannabis-related conditions: cannabinoid hyperemesis syndrome and cannabis-associated cardiovascular events. As both conditions receive more clinical attention, cases like this suggest they may co-occur or share underlying mechanisms related to cannabinoid receptor dysregulation.

Questions still open

Is there a mechanistic link between CHS and cardiovascular complications, or did this patient happen to have both? Should all CHS patients receive cardiac screening? Does the vomiting and autonomic stress of CHS itself contribute to cardiac risk?

Common questions

Can cannabis cause heart attacks?

There is growing epidemiological evidence that cannabis smoking can trigger acute coronary events, particularly coronary vasospasm, in young adults. This case report adds to that evidence but cannot prove causation on its own.

What is the connection between CHS and heart problems?

A direct mechanistic link has not been established. This case report documents both conditions occurring in the same patient. It is possible they share underlying mechanisms related to cannabinoid receptor dysregulation, but this remains speculative.

Read the original research

Coronary vasospasm complicating cannabinoid hyperemesis syndrome.

Journal of cardiology cases, 15(4), 115-118

View on PubMed ↗Publisher’s paper ↗

Citation

Pierard, Sophie; Hantson, Philippe. (2017). Coronary vasospasm complicating cannabinoid hyperemesis syndrome.. Journal of cardiology cases, 15(4), 115-118. https://doi.org/10.1016/j.jccase.2016.12.001