Marijuana Use and MI

A 56-year-old man with past history of coronary artery disease (status post-stent placement to mid left anterior descending artery 5 years ago), diabetes mellitus, and hypertension presented with complaint of acute substernal chest pressure for the past half hour. He was smoking marijuana with his friends about 1 hour prior. The pain was similar to the chest pain that he experienced 5 years ago that resulted in stent placement. He is a current smoker, social drinker, and smokes marijuana occasionally. Physical examination revealed a man with moderate discomfort and with injected conjunctiva. Cardiac and lung examination were normal.

Vital signs were a heart rate of 110 bpm, blood pressure of 148/92 mmHg, and afebrile status. Initial troponin I was 0.6 ng/ml (normal is <0.05 ng/ml), which peaked to 2.10 ng/ml 6 hours later. Electrocardiography was performed (Figure 1).

Figure 1

Figure 1

What is the best answer with regard to marijuana use in this patient?

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