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We read with interest the study by Ladha et al describing young adults (aged 18-44 yr) with myocardial infarctions (MI) and recent cannabis use; smoking was the primary route of consumption.1 Unfortunately, the findings described in this paper are not limited to adults. We recently reported on a 16-year-old adolescent who presented to our pediatric institution for chest pain after smoking cannabis with an electrocardiogram revealing diffuse ST-segment elevations and echocardiogram showing global left ventricular dysfunction.2 Comprehensive toxicology testing revealed only a Δ-9 tetrahydrocannabinol (THC) metabolite and was negative for cocaine and several other synthetic cannabinoids; an extensive infectious work-up was unremarkable making myocarditis unlikely. No focal coronary lesions or obstruction were detected during catheterization, with a right ventricular septal endomyocardial biopsy obtained 36 hours after chest pain onset demonstrating a subendocardial acute MI.
Cardiac complications of pediatric cannabis exposure described in the literature include tachycardia, bradycardia, and hypotension.3 Further, an 11-month old died after cannabis exposure with myocarditis diagnosed at autopsy.4 As cannabis use becomes more liberalized, pediatric exposures have increased.5 In 2020, the American Heart Association released a Scientific Statement summarizing the cardiovascular implications of cannabis; cardiomyopathy, MI, arrhythmias/sudden death and cerebral vascula...
Show MoreCompeting Interests: None declared.References
- 1. Ladha K, Mistry N, Wijeysundera DN et al. Recent cannabis use and myocardial infarction in young adults: a cross-sectional study. CMAJ 2021; 193(35):E1377-84.
- 2. Toce MS, Farias M, Powell AJ et al. Myocardial infarct after marijuana inhalation in a 16-year-old adolescent boy. Pediatr Dev Pathol 2019; 22(1):1320-21.
- 3. Amirshahi MM, Moss MJ, Smith SW et al. ACMT Position Statement: Addressing pediatric cannabis exposure. J Med Toxicol 2019; 15:212-14.
- 4. Nappe TM, Hoyte CO. Pediatric death due to myocarditis after exposure to cannabis. Clin Pract Cases Emerg Med 2017; 1(3):166-70.
- 5. Whitehill JM, Harrington C, Lang C et al. Incidence of pediatric cannabis exposure among children and teenagers ages 0-19 years before and after medical marijuana legalization in Massachusetts. JAMA Netw Open 2019; 2(8): e1999456.