A 28-year-old with cannabinoid hyperemesis syndrome also developed a heart rhythm abnormality | Research

The takeaway

A 28-year-old male presenting to the ED with suspected gastritis was found to have ventricular bigeminy on EKG and was ultimately diagnosed with cannabinoid hyperemesis syndrome, highlighting potential cardiac involvement.

Emergency physicians, cardiologists, and clinicians managing CHS presentations.

Ventricular bigeminy detected on EKG in a 28-year-old CHS patient

What the researchers found

CHS presentation included ventricular bigeminy (alternating normal and premature ventricular heartbeats) detected on the pre-arrival EMS EKG. This cardiac arrhythmia in the context of CHS may relate to electrolyte disturbances from severe vomiting or direct cannabinoid cardiac effects.

Why it matters

CHS is typically considered a gastrointestinal condition, but this case demonstrates potential cardiac complications. Arrhythmias in CHS patients may be underrecognized if cardiac monitoring is not performed.

The numbers in context

28-year-old male. Ventricular bigeminy on pre-arrival EKG. Diagnosed with cannabinoid hyperemesis syndrome.

How the study worked

Single case report of a 28-year-old male presenting to the ED via EMS with symptoms initially attributed to gastritis. Diagnosed with CHS after workup including EKG showing ventricular bigeminy.

What this study cannot tell us

Single case report. Cannot determine whether bigeminy was caused by CHS, electrolyte disturbance from vomiting, direct cannabinoid effects, or coincidental. No long-term follow-up reported.

How to read the evidence

Single case report. Alerts clinicians to a possible complication but cannot establish frequency or causation.

When this study was published

Published 2023.

The bigger picture

As CHS cases increase in EDs, understanding the full spectrum of complications, including cardiac, is important for appropriate workup and monitoring. Severe vomiting from any cause can lead to electrolyte disturbances that trigger arrhythmias.

Questions still open

How common are cardiac arrhythmias in CHS presentations? Should routine EKG monitoring be standard in suspected CHS cases?

Common questions

Can CHS affect the heart?

This case report describes a heart rhythm abnormality in a patient with CHS. Whether this was caused by the severe vomiting (leading to electrolyte imbalances), direct effects of cannabis on the heart, or coincidence is unclear. It highlights that CHS may have complications beyond the gastrointestinal tract.

What is ventricular bigeminy?

It is a heart rhythm pattern where every normal heartbeat is followed by a premature ventricular contraction. While not always dangerous, it can indicate electrolyte imbalances, heart disease, or other underlying issues that may need treatment.

Read the original research

Cannabinoid hyperemesis syndrome presenting with ventricular bigeminy.

Journal of cannabis research, 5(1), 36

View on PubMed ↗Publisher’s paper ↗

Citation

Wong, Jeffrey; Gill, Muneet; Stead, Thor; Huang, Derrick; Ganti, Latha. (2023). Cannabinoid hyperemesis syndrome presenting with ventricular bigeminy.. Journal of cannabis research, 5(1), 36. https://doi.org/10.1186/s42238-023-00203-x