A single fatal case links high-potency cannabis use with cardiac collapse

Fatal Cannabis-Associated Cardiovascular Toxicity Following High-Potency Cannabis Use: An Integrated Clinicopathologic Investigation.

The American journal of forensic medicine and pathology • • Highly Relevant
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AI Summary

This case report investigates whether cannabis exposure was associated with sudden cardiac collapse in a 28-year-old man who developed ventricular fibrillation while smoking a legally purchased product labeled as containing 29.9% Δ9-THC. He survived resuscitation but developed severe hypoxic-ischemic encephalopathy, and life support was withdrawn 6 days later. ECGs and cardiac biomarkers showed evolving signs of heart injury.

Autopsy found a structurally normal heart with open coronary arteries but patchy acute heart-muscle injury. Toxicology confirmed cannabis exposure, and cardiac genetic testing found no pathogenic or likely pathogenic variants. The authors consider transient reduced blood flow from coronary vasospasm a likely explanation, while noting that an initial arrhythmia followed by injury from restored blood flow cannot be ruled out. This is a single case: it supports a close temporal association, but cannot establish that cannabis caused the collapse or determine how often this risk occurs. This is an abstract-based summary, not a review of the full text.

💡 Key Findings

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A 28-year-old man developed ventricular fibrillation while smoking a cannabis product labeled as containing 29.9% Δ9-THC.
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Autopsy showed patchy acute heart-muscle injury despite a structurally normal heart and widely patent coronary arteries.
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The authors favor transient coronary vasospasm as a possible cause, but cannot exclude primary ventricular arrhythmia followed by ischemia-reperfusion injury.
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This single case supports a close temporal association, but cannot establish causation or estimate the frequency of cardiovascular risk.
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📄 Original Abstract

Cannabis has been associated with acute cardiovascular complications, including ventricular arrhythmias and myocardial infarction, particularly in otherwise healthy young adults. We report the death of a 28-year-old man who suffered from witnessed ventricular fibrillation while smoking a legally purchased cannabis product labeled as containing 29.9% Δ9-tetrahydrocannabinol (Δ9-THC). Sustained return of spontaneous circulation was achieved after ∼50 minutes of resuscitation. Despite intensive care, severe hypoxic-ischemic encephalopathy developed, and life support was withdrawn 6 days later. Serial ECGs demonstrated evolving ischemic abnormalities accompanied by a dynamic rise in cardiac biomarkers. Autopsy revealed a structurally normal heart with widely patent coronary arteries and patchy acute subendocardial myocardial injury/infarction. Antemortem toxicology demonstrated Δ9-THC and 11-nor-9-carboxy-Δ9-tetrahydrocannabinol, confirming cannabis exposure, while comprehensive cardiac genetic testing identified no pathogenic or likely pathogenic variants. The integrated clinical, electrocardiographic, toxicological, pathologic, and genetic findings support acute cannabis-associated cardiovascular toxicity occurring in close temporal association with high-potency cannabis use. Transient myocardial ischemia secondary to coronary vasospasm is favored, although primary ventricular arrhythmia with secondary global ischemia-reperfusion injury cannot be excluded retrospectively. This case highlights the importance of comprehensive clinicopathologic investigation when evaluating sudden cardiovascular collapse following cannabis exposure.

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