[A 38 YEARS-OLD YOUNG MALE WITH CHEST PAIN AND ECG CHANGES].

Coronary vasospasm is a well-known condition causing acute chest syndrome and can lead to myocardial infarction, ventricular arrhythmias, and even sudden cardiac death. While there are extensive case series showing the association of coronary vasospasm with drugs like cocaine, the association of marijuana with coronary vasospasm has not been reported frequently. When smoked, marijuana results in a rapid, dose-dependent tachycardia, an increase in blood pressure, and an increase in cardiac output. This in turn leads to increased oxygen demand, which is augmented by the vasoconstriction endothelial damage by smoking and activation of cannabinoid receptor 1 ( CB1) by marijuana. We presented a case of a 38-year-old young male who was admitted with chest pain, ST elevation in electrocardiogram (ECG) and normal coronary arteries at cardiac catheterization and a positive Acetylcholine Provocation test. With the legalization of marijuana and medical cannabis in certain states, marijuana-related hospitalizations and Emergency Room visits are likely to increase. It is therefore important for clinicians to know the various effects of marijuana, especially potentially fatal ones like coronary vasospasm. This case illustrates the importance of recognition of vasospasm in patients taking marijuana .Physicians should consider this in their differential diagnosis of patients presenting with chest pain and history of cannabis use.