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Cases Journal
Open AccesCase Report
Cardiac arrest following cannabis use: a case reportAbdo H
Sattout* and Mark F Nicol
Address: Department of Emergency Medicine, Macclesfield District
General Hospital, Victoria Road, Macclesfield, Cheshire, SK10 3BL,
UK
Email: Abdo H Sattout* - [email protected]; Mark F Nicol
- [email protected]
* Corresponding author
Abstract
Background: Cannabis, orMarijuana, remains one of the most
universally used recreational drugs.Over the last four decades, its
popularity has risen considerably as it became easily accessible
and
relatively affordable. Peak use is amongst the young aged 18 to
25 years, although these figures are
now shifting towards earlier teens. A strongly installed culture
still regards cannabis a harmless
drug, yet as more reports have shown there are considerable
adverse cardiovascular events linked
with its use.
Case Presentation: In this paper, we present the case of a
15-year-old male who suffered a
cardiac arrest following cannabis use and survived the
episode.
Conclusion: Cardiac arrest is a rare and possibly fatal
consequence of cannabis use. Publicawareness should be raised by
extensively promoting all potential complications associated with
its
use.
IntroductionThe recreational use of cannabis, or marijuana, has
beenon the rise since the 1960s. Its popularity has been cata-lysed
by an easy accessibility and affordability. Peak use isgenerally
amongst the young aged 18 to 25 years [1-3],although these figures
are now shifting towards earlierteens [2]. Nevertheless, a strongly
installed culture still
regards cannabis harmless when compared to other exist-ing
illicit drugs [1]. As more reports have shown, there
areconsiderable adverse cardiovascular events linked with
itsuse.
Case ReportA 15-year-old English Caucasian male was brought to
ouremergency department having suffered a witnessed car-diac
arrest, following the use of alcohol and cannabis withfriends.
Paramedics attended the scene within three min-utes of call being
passed: cardiopulmonary resuscitation
(CPR) was in progress by the patient's friends, and the
firstrecorded rhythm was asystole. After two minutes of CPR,the
rhythm changed into ventricular fibrillation (VF)
which was successfully cardioverted into a sinus rhythmwith a
single DC shock (200 J).
On arrival to hospital, the patient was maintaining his air-
way with respiratory arrhythmia. His vital signs showed ablood
pressure (BP) of 115/86, a heart rate (HR) of 86bpm and a recorded
GCS of 4 out of 15. In view of the res-piratory arrhythmia and
impaired GCS, he was intubatedand ventilated.
Investigations conducted in the emergency departmentshowed the
initial 12-lead electrocardiogram (ECG) to bein a normal sinus
rhythm without any acute ischaemia.No changes were identified on
subsequent 12-lead ECGs.Urine drug screen (Princeton BioMeditech
Corp., Accu-
Published: 19 November 2009
Cases Journal2009, 2:208 doi:10.1186/1757-1626-2-208
Received: 12 October 2009Accepted: 19 November 2009
This article is available from:
http://www.casesjournal.com/content/2/1/208
2009 Sattout and Nicol; licensee BioMed Central Ltd.This is an
Open Access article distributed under the terms of the Creative
Commons Attribution License
(http://creativecommons.org/licenses/by/2.0),which permits
unrestricted use, distribution, and reproduction in any medium,
provided the original work is properly cited.
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complications included ventricular tachy-arrhythmias [3]and
atrial fibrillation [3,5,7,8].
In our case, two facts need to be addressed. Firstly, the
can-nabis causality was assumed on the result of the positive
urine drug screen; hence, a full toxicology screen was
notpursued. Secondly, an inpatient echocardiograph was alsonot
documented and later not performed as the patientfailed to attend
his outpatient's follow up. We feel theeffects of chronic cannabis
abuse were most likely poten-tiated by the alcohol consumption.
This could have led toa sudden over-parasympathetic activity along
with a pos-sible tissue ischaemia, thus triggering the asystolic
epi-sode.
It is of interest to point out that there has been no reportyet
in the literature stating an asystolic cardiac arrest fol-lowing
cannabis use and survival at a young age.
ConclusionRecreational use of cannabis will remain on the rise
witha number of potentially serious, if not fatal, conse-quences.
Availability and affordability has resulted in itbeing not only
accessible to an adult population, but alsoteenagers. Since 2004,
cannabis in the UK has been classi-fied as a 'class C' drug: a fact
that is definitely carrying animmense health implication secondary
to its consump-tion with calls already being raised to re-classify
it as a'class B'. Public awareness should be extensively
maderegarding all possible complications, and emergency phy-sicians
should not assume asystolic arrest has an inevita-
ble fatal outcome.
AbbreviationsTHC: delta-9-tetrahydrocannabinol.
ConsentWritten informed consent was obtained from the
patient'sparents for publication of this case report. A copy of
the
written consent is available for review by the Editor-in-Chief
of this journal.
Competing interestsThe authors declare that they have no
competing interests.
Authors' contributionsAS, was responsible for the case review,
literature reviewand final manuscript drafting.
MN, was responsible for the manuscript critique andreview.
All authors have read and approved the final manuscript.
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