Cardiovascular Toxicology

, Volume 12, Issue 2, pp 143–148 | Cite as

Toxic Effects of Marijuana on the Cardiovascular System

  • Balaji PratapEmail author
  • Aleksandr Korniyenko


We present a case of marijuana-induced ST segment elevation mimicking Brugada syndrome in a young man. Cannabis can have a multitude of effects on the different organ systems of the body; we take a closer look at its effects on the cardiovascular system, including acute coronary syndrome, arrhythmias and congestive heart failure.


Cannabis Acute coronary syndrome Arrhythmias Syncope Brugada syndrome 


Conflict of interest

The authors declare that they have no conflict of interest.


  1. 1.
    Nations U. World Drug Report 2008. (2008). UN: Office of drugs and crime.Google Scholar
  2. 2.
    Reece, A. S. (2009). Chronic toxicology of cannabis. Clinical toxicology (Philadelphia), 47, 517–524.CrossRefGoogle Scholar
  3. 3.
    Mittleman, M. A., Lewis, R. A., Maclure, M., Sherwood, J. B., & Muller, J. E. (2001). Triggering myocardial infarction by marijuana. Circulation, 103, 2805–2809.PubMedGoogle Scholar
  4. 4.
    Jones, R. T. (2002). Cardiovascular system effects of marijuana. Journal of Clinical Pharmacology, 42, 58S–63S.PubMedGoogle Scholar
  5. 5.
    Beaconsfield, P., Ginsburg, J., & Rainsbury, R. (1972). Marihuana smoking. Cardiovascular effects in man and possible mechanisms. New England Journal of Medicine, 287, 209–212.PubMedCrossRefGoogle Scholar
  6. 6.
    Kanakis, C., Pouget, M., & Rosen, K. M. (1979). Lack of cardiovascular effects of delta-9-tetrahydrocannabinol in chemically denervated men. Annals of Internal Medicine, 91, 571–574.PubMedGoogle Scholar
  7. 7.
    Hillard, C. J. (2000). Endocannabinoids and vascular function. Journal of Pharmacology and Experimental Therapeutics, 294, 27–32.PubMedGoogle Scholar
  8. 8.
    Martin, B. R. (2002). Identification of the endogenous cannabinoid system through integrative pharmacological approaches. Journal of Pharmacology and Experimental Therapeutics, 301, 790–796.PubMedCrossRefGoogle Scholar
  9. 9.
    Kumar, R. N., Chambers, W. A., & Pertwee, R. G. (2001). Pharmacological actions and therapeutic uses of cannabis and cannabinoids. Anaesthesia, 56, 1059–1068.PubMedCrossRefGoogle Scholar
  10. 10.
    Clark, S. C. (1975). Marihuana and the cardiovascular system. Pharmacology, Biochemistry, and Behavior, 3, 299–306.PubMedCrossRefGoogle Scholar
  11. 11.
    Benowitz, N. L., & Jones, R. T. (1975). Cardiovascular effects of prolonged delta-9-tetrahydrocannabinol ingestion. Clinical Pharmacology and Therapeutics, 18, 287–297.PubMedGoogle Scholar
  12. 12.
    Aronow, W. S., & Cassidy, J. (1974). Effect of marihuana and placebo-marihuana smoking on angina pectoris. New England Journal of Medicine, 291, 65–67.PubMedCrossRefGoogle Scholar
  13. 13.
    Gregg, J. M., Campbell, R. L., Levin, K. J., Ghia, J., & Elliott, R. A. (1976). Cardiovascular effects of cannabinol during oral surgery. Anesthesia and Analgesia, 55, 203–213.PubMedCrossRefGoogle Scholar
  14. 14.
    Mathew, R. J., Wilson, W. H., Humphreys, D., Lowe, J. V., & Wiethe, K. E. (1992). Middle cerebral artery velocity during upright posture after marijuana smoking. Acta Psychiatrica Scandinavica, 86, 173–178.PubMedCrossRefGoogle Scholar
  15. 15.
    Gash, A., Karliner, J. S., Janowsky, D., & Lake, C. R. (1978). Effects of smoking marihuana on left ventricular performance and plasma norepinephrine: studies in normal men. Annals of Internal Medicine, 89, 448–452.PubMedGoogle Scholar
  16. 16.
    Johnson, S., & Domino, E. F. (1971). Some cardiovascular effects of marihuana smoking in normal volunteers. Clinical Pharmacology and Therapeutics, 12, 762–768.PubMedGoogle Scholar
  17. 17.
    Rinaldi, L. (1994). Marijuana: A research overview. Alaska Medicine, 36, 107–113.PubMedGoogle Scholar
  18. 18.
    Ghuran, A., & Nolan, J. (2000). Recreational drug misuse: Issues for the cardiologist. Heart, 83, 627–633.PubMedCrossRefGoogle Scholar
  19. 19.
    Coumel, P. (1994). Paroxysmal atrial fibrillation: A disorder of autonomic tone? European Heart Journal, 15 (Suppl A) 9–16.Google Scholar
  20. 20.
    Fuster, V., Ryden, L. E., & Cannom, D. S., et al. (2011). ACCF/AHA/HRS focused updates incorporated into the ACC/AHA/ESC 2006 guidelines for the management of patients with atrial fibrillation: A report of the American College of Cardiology Foundation/American Heart Association Task Force on practice guidelines. Circulation,123 e269–e367.Google Scholar
  21. 21.
    Daccarett, M., Freih, M., & Machado, C. (2007). Acute cannabis intoxication mimicking brugada-like ST segment abnormalities. International Journal of Cardiology, 119, 235–236.PubMedCrossRefGoogle Scholar
  22. 22.
    Kosior, D. A., Filipiak, K. J., Stolarz, P., & Opolski, G. (2001). Paroxysmal atrial fibrillation following marijuana intoxication: A two-case report of possible association. International Journal of Cardiology, 78, 183–184.PubMedCrossRefGoogle Scholar
  23. 23.
    Akins, D., & Awdeh, M. R. (1981). Marijuana and second-degree AV block. Southern Medical Journal, 74, 371–373.PubMedCrossRefGoogle Scholar
  24. 24.
    Clark, S. C., Greene, C., Karr, G. W., MacCannell, K. L., & Milstein, S. L. (1974). Cardiovascular effects of marihuana in man. Canadian Journal of Physiology and Pharmacology, 52, 706–719.PubMedCrossRefGoogle Scholar
  25. 25.
    Roth, W. T., Tinkleinberg, J. R., Kopell, B. S., & Hollister, L. E. (1973). Continuous electrocardiographic monitoring during marihuana intoxication. Clinical Pharmacology and Therapeutics, 14, 533–540.PubMedGoogle Scholar
  26. 26.
    Aronow, W. S., & Cassidy, J. (1975). Effect of smoking marihuana and of a high-nicotine cigarette on angina pectoris. Clinical Pharmacology and Therapeutics, 17, 549–554.PubMedGoogle Scholar
  27. 27.
    Sarafian, T. A., Magallanes, J. A., Shau, H., Tashkin, D., & Roth, M. D. (1999). Oxidative stress produced by marijuana smoke. An adverse effect enhanced by cannabinoids. American Journal of Respiratory Cell and Molecular Biology, 20, 1286–1293.PubMedGoogle Scholar
  28. 28.
    Chesher, G., & Hall, W. (1999). Effects of cannabis on the cardiovascular and gastrointestinal systems. In H. Kalant, W. Corrigall, W. Hall, & R. Smart (Eds.), The Health Effects of Cannabis (pp. 437–458). Toronto: Centre for Addiction and Mental Health.Google Scholar
  29. 29.
    Cote, M., Matias, I., Lemieux, I., et al. (2007). Circulating endocannabinoid levels, abdominal adiposity and related cardiometabolic risk factors in obese men. International Journal of Obesity (London), 31, 692–699.Google Scholar
  30. 30.
    Tashkin, D. P., Coulson, A. H., Clark, V. A., et al. (1987). Respiratory symptoms and lung function in habitual heavy smokers of marijuana alone, smokers of marijuana and tobacco, smokers of tobacco alone, and nonsmokers. The American Review of Respiratory Disease, 135, 209–216.PubMedGoogle Scholar
  31. 31.
    Bloom, J. W., Kaltenborn, W. T., Paoletti, P., Camilli, A., & Lebowitz, M. D. (1987). Respiratory effects of non-tobacco cigarettes. British Medical Journal (Clinical Research Ed.), 295, 1516–1518.CrossRefGoogle Scholar
  32. 32.
    Higgins, M., Keller, J. B., Wagenknecht, L. E., et al. (1991). Pulmonary function and cardiovascular risk factor relationships in black and in white young men and women. The CARDIA study. Chest, 99, 315–322.PubMedCrossRefGoogle Scholar
  33. 33.
    Friedman, G. D., Klatsky, A. L., & Siegelaub, A. B. (1974). The leukocyte count as a predictor of myocardial infarction. New England Journal of Medicine, 290, 1275–1278.PubMedCrossRefGoogle Scholar
  34. 34.
    Scherwitz, L. W., Perkins, L. L., Chesney, M. A., Hughes, G. H., Sidney, S., & Manolio, T. A. (1992). Hostility and health behaviors in young adults: The CARDIA study. Coronary artery risk development in young adults study. American Journal of Epidemiology, 136, 136–145.PubMedGoogle Scholar
  35. 35.
    Iribarren, C., Sidney, S., Bild, D. E., et al. (2000). Association of hostility with coronary artery calcification in young adults: The CARDIA study. Coronary artery risk development in young adults. Journal of the American Medical Association, 283, 2546–2551.PubMedCrossRefGoogle Scholar
  36. 36.
    Friedman, G. D., Tekawa, I., Grimm, R. H., Manolio, T., Shannon, S. G., & Sidney, S. (1990). The leucocyte count: correlates and relationship to coronary risk factors: The CARDIA study. International Journal of Epidemiology, 19, 889–893.PubMedCrossRefGoogle Scholar
  37. 37.
    Antzelevitch, C., Brugada, P., Borggrefe, M., et al. (2005). Brugada syndrome: Report of the second consensus conference: Endorsed by the heart rhythm society and the European heart rhythm association. Circulation, 111, 659–670.PubMedCrossRefGoogle Scholar
  38. 38.
    Brugada, P., Brugada, J., & Brugada, R. (2000). Arrhythmia induction by antiarrhythmic drugs. Pacing and Clinical Electrophysiology, 23, 291–292.PubMedCrossRefGoogle Scholar
  39. 39.
    Brugada, R., Brugada, J., Antzelevitch, C., et al. (2000). Sodium channel blockers identify risk for sudden death in patients with ST-segment elevation and right bundle branch block but structurally normal hearts. Circulation, 101, 510–515.PubMedGoogle Scholar
  40. 40.
    Antzelevitch, C., & Brugada, R. (2002). Fever and Brugada syndrome. Pacing and Clinical Electrophysiology, 25, 1537–1539.PubMedCrossRefGoogle Scholar
  41. 41.
    Shimizu, W., Antzelevitch, C., Suyama, K., et al. (2000). Effect of sodium channel blockers on ST segment, QRS duration, and corrected QT interval in patients with Brugada syndrome. Journal of Cardiovascular Electrophysiology, 11, 1320–1329.PubMedCrossRefGoogle Scholar
  42. 42.
    Jones, R. T., Benowitz, N. L., & Herning, R. I. (1981). Clinical relevance of cannabis tolerance and dependence. Journal of Clinical Pharmacology, 21, 143S–152S.PubMedCrossRefGoogle Scholar
  43. 43.
    Mittleman, M. A., Mintzer, D., Maclure, M., Tofler, G. H., Sherwood, J. B., & Muller, J. E. (1999). Triggering of myocardial infarction by cocaine. Circulation, 99, 2737–2741.PubMedGoogle Scholar
  44. 44.
    Renault, P. F., Schuster, C. R., Heinrich, R., & Freeman, D. X. (1971). Marihuana: Standardized smoke administration and dose effect curves on heart rate in humans. Science, 174, 589–591.PubMedCrossRefGoogle Scholar
  45. 45.
    Davies, M. J., & Thomas, A. C. (1985). Plaque fissuring—the cause of acute myocardial infarction, sudden ischaemic death, and crescendo angina. British Heart Journal, 53, 363–373.PubMedCrossRefGoogle Scholar
  46. 46.
    Pacher, P., Batkai, S., & Kunos, G. (2006). The endocannabinoid system as an emerging target of pharmacotherapy. Pharmacological Reviews, 58, 389–462.PubMedCrossRefGoogle Scholar
  47. 47.
    Pacher, P., & Steffens, S. (2009). The emerging role of the endocannabinoid system in cardiovascular disease. Semin Immunopathol, 31, 63–77.PubMedCrossRefGoogle Scholar
  48. 48.
    Izzo, A. A., Borrelli, F., Capasso, R., Di Marzo, V., & Mechoulam, R. (2009). Non-psychotropic plant cannabinoids: New therapeutic opportunities from an ancient herb. Trends in Pharmacological Sciences, 30, 515–527.PubMedCrossRefGoogle Scholar
  49. 49.
    Rudz, R., Baranowska, U., & Malinowska, B. (2008). Function of cannabinoids in heart failure. Postȩpy higieny i medycyny doświadczalnej (Online), 62, 174–184.Google Scholar
  50. 50.
    Shimizu, A. (2010). Is this a philosophic issue? Do patients with drug-induced Brugada type ECG have poor prognosis? (Pro). Circulation Journal, 74, 2455–2463.PubMedCrossRefGoogle Scholar

Copyright information

© Springer Science+Business Media, LLC 2011

Authors and Affiliations

  1. 1.Department of MedicineSt. Luke’s–Roosevelt Hospital CenterNew YorkUSA
  2. 2.Columbia University College of Physicians and SurgeonsNew YorkUSA

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