K2—Not the Spice of Life; Synthetic Cannabinoids and ST Elevation Myocardial Infarction: A Case Report
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The adverse effects of synthetic cannabinoids are not well-described nor have they been thoroughly studied.
A 16-year-old male with a past medical history of asthma and attention deficit hyperactivity disorder (ADHD) presented to the emergency department (ED) complaining of 24 h of substernal pressure associated with dyspnea, nausea, and vomiting. He reported smoking tobacco cigarettes daily and occasional marijuana use but denied recent use of marijuana. The initial electrocardiogram (EKG) revealed ST-segment elevations in leads II, III, AVF, and V4-V6. The initial troponin level was reported as 1.47 ng/mL, and the initial creatine kinase MB (CKMB) level was 17.5 ng/mL. The patient admitted to smoking “K2” 60–90 min prior to the onset of symptoms. The patient manifested persistent ST elevations with a peak troponin of 8.29 ng/mL. The urine drug immunoassay was positive for benzodiazepines and opiates. Cardiac catheterization revealed normal coronary arteries, no wall motion abnormalities, and normal systolic function.
Synthetic cannabinoids may have significant potential adverse effects. Chest pain due to myocardial ischemia is rare in adolescents. When evaluating patients with chest pain, it is important to elicit a detailed drug history, specifically inquiring about synthetic cannabinoid use. Urine drug immunoassays may be unreliable and in this case did not detect synthetic cannabinoids.
KeywordsCannabinoids Drugs of abuse Myocardial infarction
- 1.National Center for Health Statistics. Health Status and Determinants. In: Health, United States, 2012: with special feature on emergency care. U.S. Department of Health and Human Services. 2012. http://www.cdc.gov/nchs/data/hus/hus12.pdf. Accessed 4 April 2014.
- 4.European Monitoring Centre for Drugs and Drug Addiction. Understanding the ‘Spice’ phenomenon. In: Thematic papers. 2009. http://www.emcdda.europa.eu/publications/thematic-papers/spice. Accessed 3 April 2014.
- 15.Chimalakonda KC, Seely KA, Bratton SM, Brents LK, Moran CL, Endres GW et al (2012) Cytochrome P450-mediated oxidative metabolism of abused synthetic cannabinoids found in K2/Spice: identification of novel cannabinoid receptor ligands. Drug Metab Dispos 40(11):2174–84CrossRefPubMedCentralPubMedGoogle Scholar