背景:大麻是全球消费最多的药物,使用者数量正在增加,尤其是在年轻人中。此外,大麻潜在的治疗特性重新引起了人们的兴趣,使其可用作各种疾病的治疗方法。尽管很少,大麻消费与心律失常等心血管疾病有关,心肌梗死(MI)和潜在的猝死。
方法:一名24岁女性因最近发现7个月前植入的植入式环形记录仪(ILR)出现16秒心搏停止,被她的心脏病专家送到急诊科就诊。她宣称自己是大量大麻使用者(每天至少吸5支大麻烟,没有和烟草混在一起,不少于12年),所有晕头病都是在大麻消费后不久发生的。在与心脏团队集体讨论后,晕厥单位,电生理学家和毒理学家,由于晕厥发作的创伤风险较高,我们决定植入具有心率反应算法的双腔起搏器.24个月随访顺利。
结论:大麻对心血管的影响尚不为人所知,虽然罕见,其中我们发现了缺血发作,快速性心律失常,有症状的窦性心动过缓,窦性停搏,室性心搏停止和可能的死亡。由于医疗和娱乐目的的大麻消费不断增长,与大麻使用相关的心血管疾病可能变得越来越频繁。根据贫穷的文学,我们认为,根据习惯的持续时间,大麻可能会产生相反的不良影响。急性给药增加交感神经紧张,减少副交感神经紧张;相反,在长期摄入的情况下,观察到相反的效果:重复给药减少交感神经活动并增加副交感神经活动。临床医生应意识到与使用大麻相关的心血管并发症的风险增加,并应调查其消费量,尤其是在出现心律失常的年轻患者中。
Cannabis is the most consumed drug worldwide and number of users is increasing, particularly among youth. Moreover, cannabis potential therapeutic properties have renewed interest to make it available as a treatment for a variety of conditions. Albeit rarely, cannabis consumption has been associated with cardiovascular diseases such as arrhythmias, myocardial infarction (MI) and potentially sudden death.
A 24-year-old woman presented to the emergency department sent by her cardiologist because of a recent finding of a 16 seconds asystole on the implantable loop recorder (ILR) she implanted 7 months before for recurrent syncopes. She declared that she is a heavy cannabis user (at least 5 cannabis-cigarette per day, not mixed up with tobacco, for no less than 12 years) and all syncopes occurred shortly after cannabis consumption. After a collective discussion with the heart team, syncope unit, electrophysiologists and toxicologist, we decided to implant a dual chamber pacemaker with a rate response algorithm due to the high risk of trauma of the syncopal episodes. 24 months follow-up period was uneventful.
Cannabis cardiovascular effects are not well known and, although rare, among these we find ischemic episodes, tachyarrhythmias, symptomatic sinus bradycardia, sinus arrest, ventricular asystole and possibly death. Because of cannabis growing consumption both for medical and recreational purpose, cardiovascular diseases associated with cannabis use may become more and more frequent. In the light of the poor literature, we believe that cannabis may produce opposite adverse effects depending on the duration of the habit. Acute administration increases sympathetic tone and reduces parasympathetic tone; conversely, with chronic intake an opposite effect is observed: repetitive dosing decreases sympathetic activity and increases parasympathetic activity. Clinicians should be aware of the increased risk of cardiovascular complications associated with cannabis use and should investigate its consumption especially in young patients presenting with cardiac dysrhythmias.