Suspektna povezanost između upotrebe kanabisa i razvoja miokarditisa: rastući dijagnostički izazov i faktor rizika kod mladih odraslih osoba
Ključne reči:
miokarditis, kanabis, nsVT
Sažetak
Uvod: Akutni miokarditis se definiše kao inflamatorno oštećenje miokarda koje pogađa 4 do 14 osoba na 100 000 stanovnika. Utvrđeno je da kanabis sadrži THC za koji je dokazan negativni kardiotropni efekat - pojava tahikardije i aritmije, hipo- ili hipertenzija, vazospazam, vazodilatacija, povećan rizik za miokardni infarkt usled ubrzanog koronarnog protoka.
Prikaz slučaja: Pacijent starosti 29 godina sa simptomima palpitacije i gušenja, hospitalizovan je u jedinicu intezivne nege Klinike za kardiologiju UKC Kragujevac. Anamnestički saznajemo da je pacijent svakodnevni konzument kanabinoida u poslednja 3 meseca. Kardiološkom dijagnostikom registrovano je više epizoda nsVT. Magnetnom rezonancom srca je potvrđeno prisustvo miokarditisa. U odsustvu drugih identifikovanih uzročnika miokarditisa, najverovatniji faktor koji je mogao dovesti do ovog stanja predstavlja upotreba marihuane.
Zaključak: Miokarditis nepoznatog uzroka kod mladih pacijenata zahteva specifičan dijagnostički pristup. Standardni dijagnostički protokol za dijagnostiku miokarditisa kod mlađih pacijenta, treba obuhvatiti skrining na upotrebu psihoaktivnih supstanci.
Reference
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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.
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.
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