Cannabis use and myocarditis: a suspected association, emerging risk factor, and growing diagnostic challenge in young adults
Keywords:
myocarditis, cannabis, nsVT
Abstract
Introduction: Acute myocarditis is a inflammatory injury of the myocardium, affecting 4–14 per 100,000 individuals. Several cases of marijuana-induced myocarditis have been reported. Cannabis contains THC, which exerts negative cardiotropic effects, including tachycardia, arrhythmias, blood pressure fluctuations, vasospasm, vasodilation, and increased risk of myocardial infarction.
Case report: A 29-year-old male presented with palpitations and dyspnea and was admitted to the intensive care unit at the Cardiology Clinic, University Clinical Center Kragujevac. He had no history of acute infection or comorbidities but reported daily cannabinoid use for three months. Cardiac evaluation revealed multiple episodes of non-sustained ventricular tachycardia (nsVT). Cardiac magnetic resonance confirmed myocarditis. In the absence of other etiological factors, marijuana use was considered the most probable cause.
Conclusion: Myocarditis of unknown origin in young patients requires a targeted diagnostic approach. Standard protocols should include screening for psychoactive substance use, given its prevalence and potential cardiovascular effects.
References
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19. Harding BN, Austin TR, Floyd JS, Smith BM, Szklo M, Heckbert SR. Self-reported marijuana use and cardiac arrhythmias (from the Multiethnic Study of Atherosclerosis). Am J Cardiol 2022;177:48–52.
20. Tandon, Varun & Martinez, Jake & Mookadam, Farouk & Freiman, Samuel & Zawaneh, Michael. (2022). CANNABIS AND THE WOLF, A RISKY COMBINATION. Journal of the American College of Cardiology. 79. 2453. 10.1016/S0735-1097(22)03444-1.
2. Yao Z, Liang M, Zhu S. Infectious factors in myocarditis: a comprehensive review of common and rare pathogens. Egypt Heart J. 2024 May 24;76(1):64. doi: 10.1186/s43044-024-00493-3. PMID: 38789885; PMCID: PMC11126555.
3. Brociek E, Tymińska A, Giordani AS, Caforio ALP, Wojnicz R, Grabowski M, Ozierański K. Myocarditis: Etiology, Pathogenesis, and Their Implications in Clinical Practice. Biology (Basel). 2023 Jun 17;12(6):874. doi: 10.3390/biology12060874. PMID: 37372158; PMCID: PMC10295542.
4. Kariyanna PT, Jayarangaiah A, Singh N, et al.Marijuana induced myocarditis: a new entity oftoxic myocarditis. Am J Med Case Rep. 2018;6(9):169-172. doi: 10.12691/ajmcr-6-9-1
5. Oudah B, Al-Ameri N, Mousa A, Arshad H, Abu-Abaa M, Park S. Variant Angina and Cannabis-Induced Myocarditis: A Rare Presentation of Myocardial Inflammation. Cureus. 2023 Jun 30;15(6):e41196. doi: 10.7759/cureus.41196. PMID: 37525794; PMCID: PMC10387264.
6. Rodríguez-Castro CE, Alkhateeb H, Elfar A,Saifuddin F, Abbas A, Siddiqui T. Recurrentmyopericarditis as a complication of marijuanause. Am J Case Rep. 2014; 15:60-62. doi:10.12659/AJCR.889808
7. Tournebize J, Gibaja V, Puskarczyk E, PopovicB, Kahn J-P. Myocarditis and cannabis: Anunusual association. Toxicol Anal Clin. 2016;28(3):236. doi: 10.1016/j.toxac.2016.05.005
8. Prota C, Ravera A, Caleo O, Campanile A. Marijuana-induced toxic myocarditis: a case report and a review of the literature. J Cardiovasc Med (Hagerstown). 2022 Dec 1;23(12):814-818. doi: 10.2459/JCM.0000000000001374. Epub 2022 Sep 7. PMID: 36166341.
9. Janicijevic KM, Kocic SS, Radevic SR, Jovanovic MR, Radovanovic SM. Socioeconomic Factors Associated with Psychoactive Substance Abuse by Adolescents in Serbia. Front Pharmacol. 2017 Jun 13;8:366. doi: 10.3389/fphar.2017.00366. PMID: 28659800; PMCID: PMC5468426.
10. Uvalić J, Jovanović D, Brankovic A, Đorđević S, Koturević B. Drug use statistics in Serbia: analysing a population’s drug use stance on cannabis legalisation. In: Archibald Reiss Days – Thematic Conference Proceedings of International Significance; 2024; Belgrade, Serbia. Belgrade: University of Criminal Investigation and Police Studies; 2024. Available on: https://eskup.kpu.edu.rs/dar/article/view/547
11. Mach F, Montecucco F, Steffens S.Cannabinoid receptors in acute and chronic complications of atherosclerosis. Br JPharmacol. 2008; 153(2):290-298.
12. Kattoor A, Mehta J: Marijuana and coronaryheart disease. American College of Cardiology[https://www.acc.org/latest-in-cardiology/articles/2016/09/22/08/58/marijuana-and-coronary-heart-disease available at06/20/2022]
13. Alirezaei T, Mohammadi MKA, Irilouzadian R, Zarinparsa H. Marijuana-induced myocarditis in a 24-year-old man. Arch Clin Cases. 2022 Jul 7;9(2):69-74. doi: 10.22551/2022.35.0902.10206. PMID: 35813492; PMCID: PMC9262081.
14. Merve AO, Sobiecka P, Remeškevičius V, Taylor L, Saskoy L, Lawton S, Jones BP, Elwakeel A, Mackenzie FE, Polycarpou E, Bennett J, Rooney B. Metabolites of Cannabis Induce Cardiac Toxicity and Morphological Alterations in Cardiac Myocytes. Int J Mol Sci. 2022 Jan 26;23(3):1401. doi: 10.3390/ijms23031401. PMID: 35163321; PMCID: PMC8835806.
15. McLaren, J., Swift, W., Dillon, P. and Allsop, S. (2008), Cannabis potency and contamination: a review of the literature. Addiction, 103: 1100-1109. https://doi.org/10.1111/j.1360-0443.2008.02230.x
16. Richards JR. Mechanisms for the Risk of Acute Coronary Syndrome and Arrhythmia Associated With Phytogenic and Synthetic Cannabinoid Use. Journal of Cardiovascular Pharmacology and Therapeutics. 2020;25(6):508-522. doi:10.1177/1074248420935743
17. Beaconsfield P, Ginsburg J, Rainsbury R. Marihuana smoking. Cardiovascular effects in man and possible mechanisms. N Engl J Med 1972;287:209–212.
18. Sharma V, Bhardwaj A, Sahai A, Singh S, Shamim S. Myocardial Infarction Triggered by Marijuana Use. JACC Case Rep. 2025 Apr 16;30(8):103202. doi: 10.1016/j.jaccas.2024.103202. Epub 2025 Feb 12. PMID: 40250909; PMCID: PMC12046891.
19. Harding BN, Austin TR, Floyd JS, Smith BM, Szklo M, Heckbert SR. Self-reported marijuana use and cardiac arrhythmias (from the Multiethnic Study of Atherosclerosis). Am J Cardiol 2022;177:48–52.
20. Tandon, Varun & Martinez, Jake & Mookadam, Farouk & Freiman, Samuel & Zawaneh, Michael. (2022). CANNABIS AND THE WOLF, A RISKY COMBINATION. Journal of the American College of Cardiology. 79. 2453. 10.1016/S0735-1097(22)03444-1.
Published
2026/06/05
Section
Case report
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