Atrioventricular Nodal Reentrant Tachycardia Triggered by Edible Marijuana: A Case Report and Review of the Literature

摘要

Marijuana (Cannabis) is the most commonly produced and illicit drug used worldwide with an estimated 182.5 million users globally, constituting 3.8% of the world population. There is a rising trend in the reporting of cardiovascular complications related to cannabis use. Marijuana is composed of more than 460 chemicals with delta-9- tetrahydrocannabinol (THC) being the psychotropic ingredient. It acts via CB1 and CB2 G-protein coupled cannabinoid receptors. Various cardiac manifestations, associated with marijuana use, such as bradyarrhythmia, tachycardia, atrial fibrillation, atrial flutter, ventricular tachycardia and fibrillation, asystole have been reported so far. To the best of our knowledge, there is a single case report of atrioventricular nodal reentrant tachycardia (AVNRT) triggered by smoking marijuana. Our case report is unique and probably the only one reported, in which AVNRT is triggered by edible marijuana, which was consumed in the form of marijuana burger. As compared to inhaled marijuana, marijuana ingestion has a delayed onset ranging from half an hour to three hours, with its effect lasting up to 12 hours. The effects of marijuana on the cardiovascular system are extremely worrisome owing to the legalization of marijuana for medicinal and recreational use across many states in the USA. Our case emphasizes the importance of keeping marijuana as one of the possible causes of AVNRT, not explained by any other cause. Physicians should keep in mind while elucidating history from the patient, all the possible routes of marijuana consumption and detailed and repetitive questionnaire should be put to the patient in order to reach a conclusive diagnosis.