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Syncope and Cannabis: hypervagotonia from chronic abuse? A case report and literature review
by
Licciardi, Marco
, Cecchetto, Giovanni
, Marchetti, Maria Francesca
, Nissardi, Vincenzo
, Montisci, Massimo
, Utzeri, Elena
, Montisci, Roberta
in
Adenosine
/ Algorithms
/ Analysis
/ Angiology
/ Asystole
/ Blood pressure
/ Blood Transfusion Medicine
/ Bradycardia
/ Cannabidiol
/ Cannabis
/ Cardiac arrest
/ Cardiac pace-maker
/ Cardiac patients
/ Cardiac Surgery
/ Cardiology
/ Cardiovascular diseases
/ Cardiovascular effects
/ Care and treatment
/ Case Report
/ Case reports
/ Complications and side effects
/ Convulsions & seizures
/ Development and progression
/ Diagnosis
/ Dyspnea
/ Electrocardiography
/ Emergency medical care
/ Fainting
/ Health aspects
/ Heart attack
/ Heart rate
/ ILR implantation
/ Implants, Artificial
/ Internal Medicine
/ Ischemia
/ Literature reviews
/ Marijuana
/ Marijuana industry
/ Medical research
/ Medicine
/ Medicine & Public Health
/ Medicine, Experimental
/ Myocardial infarction
/ Pacemakers
/ Parasympathetic nervous system
/ Patients
/ Prosthesis
/ Recurrent Syncope
/ Risk factors
/ Sinuses
/ Smoking
/ Sympathetic nervous system
/ Syncope
/ Tachycardia
/ Teenagers
/ Tetrahydrocannabinol
/ THC
/ Ventricle
/ Youth
2023
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Syncope and Cannabis: hypervagotonia from chronic abuse? A case report and literature review
by
Licciardi, Marco
, Cecchetto, Giovanni
, Marchetti, Maria Francesca
, Nissardi, Vincenzo
, Montisci, Massimo
, Utzeri, Elena
, Montisci, Roberta
in
Adenosine
/ Algorithms
/ Analysis
/ Angiology
/ Asystole
/ Blood pressure
/ Blood Transfusion Medicine
/ Bradycardia
/ Cannabidiol
/ Cannabis
/ Cardiac arrest
/ Cardiac pace-maker
/ Cardiac patients
/ Cardiac Surgery
/ Cardiology
/ Cardiovascular diseases
/ Cardiovascular effects
/ Care and treatment
/ Case Report
/ Case reports
/ Complications and side effects
/ Convulsions & seizures
/ Development and progression
/ Diagnosis
/ Dyspnea
/ Electrocardiography
/ Emergency medical care
/ Fainting
/ Health aspects
/ Heart attack
/ Heart rate
/ ILR implantation
/ Implants, Artificial
/ Internal Medicine
/ Ischemia
/ Literature reviews
/ Marijuana
/ Marijuana industry
/ Medical research
/ Medicine
/ Medicine & Public Health
/ Medicine, Experimental
/ Myocardial infarction
/ Pacemakers
/ Parasympathetic nervous system
/ Patients
/ Prosthesis
/ Recurrent Syncope
/ Risk factors
/ Sinuses
/ Smoking
/ Sympathetic nervous system
/ Syncope
/ Tachycardia
/ Teenagers
/ Tetrahydrocannabinol
/ THC
/ Ventricle
/ Youth
2023
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Syncope and Cannabis: hypervagotonia from chronic abuse? A case report and literature review
by
Licciardi, Marco
, Cecchetto, Giovanni
, Marchetti, Maria Francesca
, Nissardi, Vincenzo
, Montisci, Massimo
, Utzeri, Elena
, Montisci, Roberta
in
Adenosine
/ Algorithms
/ Analysis
/ Angiology
/ Asystole
/ Blood pressure
/ Blood Transfusion Medicine
/ Bradycardia
/ Cannabidiol
/ Cannabis
/ Cardiac arrest
/ Cardiac pace-maker
/ Cardiac patients
/ Cardiac Surgery
/ Cardiology
/ Cardiovascular diseases
/ Cardiovascular effects
/ Care and treatment
/ Case Report
/ Case reports
/ Complications and side effects
/ Convulsions & seizures
/ Development and progression
/ Diagnosis
/ Dyspnea
/ Electrocardiography
/ Emergency medical care
/ Fainting
/ Health aspects
/ Heart attack
/ Heart rate
/ ILR implantation
/ Implants, Artificial
/ Internal Medicine
/ Ischemia
/ Literature reviews
/ Marijuana
/ Marijuana industry
/ Medical research
/ Medicine
/ Medicine & Public Health
/ Medicine, Experimental
/ Myocardial infarction
/ Pacemakers
/ Parasympathetic nervous system
/ Patients
/ Prosthesis
/ Recurrent Syncope
/ Risk factors
/ Sinuses
/ Smoking
/ Sympathetic nervous system
/ Syncope
/ Tachycardia
/ Teenagers
/ Tetrahydrocannabinol
/ THC
/ Ventricle
/ Youth
2023
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Syncope and Cannabis: hypervagotonia from chronic abuse? A case report and literature review
Journal Article
Syncope and Cannabis: hypervagotonia from chronic abuse? A case report and literature review
2023
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Overview
Background
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.
Case presentation
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.
Conclusions
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.
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