A Fatal Case of Coronary Thrombosis in a Young Male Triggered by Marijuana Use

The use of marijuana for therapeutic and recreational purposes is rising. The effects of marijuana on the central nervous system are well documented, but its effect on the cardiovascular system is not well understood. The available evidence suggests that there is an increased risk of cardiac arrhythmia and myocardial infarction with continued use of marijuana. Case reports have documented instances of ST-elevation myocardial infarction (STEMI) in otherwise healthy individuals with a history of marijuana consumption. In this study, we report a rare autopsy study of a young man with a history of marijuana use. We report an autopsy study of a 34-year-old man with no previous medical history except for marijuana use who had a sudden cardiac death. A complete autopsy was performed and samples for toxicological examination were obtained. Gross examination was normal except for mild cardiomegaly. Microscopic examination revealed focal complete occlusion of the proximal left anterior descending coronary artery due to an organized thrombus. The coronary arteries proximal and distal to the occlusion area showed no atherosclerotic plaques or thrombus. Trichrome stain and elastin stain were performed. There was no underlying atherosclerosis in the other coronary arteries. No acute myocardial infarction was noted. Blood and vitreous fluid toxicology revealed elevated levels of delta-9THC (tetrahydrocannabinol) (50 mg/mL). Only rare reports of the effect of marijuana on the cardiovascular system exist in the literature. The proposed mechanisms include arteritis, vasospasm, and platelet aggregation. Our case illustrates that organized coronary thrombosis leading to coronary artery occlusion may be the cause of myocardial ischemia and fatal cardiac arrhythmia in individuals with marijuana use. This case also highlights the importance of considering coronary artery occlusion without atherosclerosis as a cause of sudden death and emphasizes the potential role of drug use in contributing to adverse cardiovascular outcomes. Cannabis smoking is a potential predisposing factor in young healthy adults.