Significance of New RBBB Post Marijuana Consumption
Image Modality: Angiogram
The figure shows an ECG of a 22-year-old male patient with no significant medical history except for daily marijuana use who presented with severe retrosternal chest pain after marijuana use. Upon arrival to the emergency department, a repeated ECG revealed the development of a new RBBB. Although ECGs were suggestive for acute myocardial infarction, it was believed that the probability of atherosclerotic coronary artery disease was very low, and patient underwent an emergent computed tomography scan with contrast with negative results for acute pulmonary embolism or aortic dissection. Due to recurrent episodes of chest pain, the patient underwent an emergent coronary angiogram, which demonstrated a large thrombus in the proximal LAD. Mechanical thrombectomy adequately removed the intracoronary thrombus. The recurrent use of marijuana is believed to cause acute myocardial infarction by increasing vasospastic, procoagulant, and prothrombotic effects.1 Anatomically, the right bundle branch blood supply is mainly from the proximal LAD or the first septal perforator branch of the LAD.2 This case emphasizes the importance of considering acute STEMI as differential diagnoses of acute chest pain in young patients with no significant medical history after recurrent marijuana consumption and points to the importance of early recognition of new RBBB as a marker for increased long-term mortality.
- Lee J, Sharma N, Kazi F, et al. Cannabis and Myocardial Infarction: Risk Factors and Pathogenetic Insights. Scifed J Cardiol 2017;1:1000004.
- Wang J, Luo H, Kong C, et al. Prognostic value of new-onset right bundle-branch block in acute myocardial infarction patients: a systematic review and meta-analysis. PeerJ 2018;6:e4497.
Date: March 09, 2020
Clinical Topics: Acute Coronary Syndromes, Arrhythmias and Clinical EP, Cardiac Surgery, Invasive Cardiovascular Angiography and Intervention, Noninvasive Imaging, Prevention, Vascular Medicine, Atherosclerotic Disease (CAD/PAD), EP Basic Science, Cardiac Surgery and Arrhythmias, Interventions and ACS, Interventions and Coronary Artery Disease, Interventions and Imaging, Interventions and Vascular Medicine, Angiography, Echocardiography/Ultrasound, Nuclear Imaging, Smoking
Keywords: Diagnostic Imaging, Cardiac Imaging Techniques, Acute Coronary Syndrome, Angiography, Coronary Angiography, Myocardial Infarction, Marijuana Smoking, Bundle-Branch Block, Cannabis, Coronary Artery Disease, Heart Ventricles, Diagnosis, Differential, Electrocardiography, Chest Pain, Arteries, Thrombosis, Emergency Service, Hospital, Arteriovenous Fistula, Pulmonary Embolism, Aneurysm, Dissecting, Fluoroscopy, Ultrasonography, Interventional, Thrombectomy, Tomography, Pacemaker, Artificial