title: K2--not the spice of life; synthetic cannabinoids and ST elevation myocardial infarction: a case report.
abstract: BACKGROUND
  The adverse effects of synthetic cannabinoids are not well-described nor have they been thoroughly studied.
  
  
  METHODS
  A 16-year-old male with a past medical history of asthma and attention deficit hyperactivity disorder (ADHD) presented to the emergency department (ED) complaining of 24 h of substernal pressure associated with dyspnea, nausea, and vomiting. He reported smoking tobacco cigarettes daily and occasional marijuana use but denied recent use of marijuana. The initial electrocardiogram (EKG) revealed ST-segment elevations in leads II, III, AVF, and V4-V6. The initial troponin level was reported as 1.47 ng/mL, and the initial creatine kinase MB (CKMB) level was 17.5 ng/mL. The patient admitted to smoking "K2" 60-90 min prior to the onset of symptoms. The patient manifested persistent ST elevations with a peak troponin of 8.29 ng/mL. The urine drug immunoassay was positive for benzodiazepines and opiates. Cardiac catheterization revealed normal coronary arteries, no wall motion abnormalities, and normal systolic function.
  
  
  CONCLUSIONS
  Synthetic cannabinoids may have significant potential adverse effects. Chest pain due to myocardial ischemia is rare in adolescents. When evaluating patients with chest pain, it is important to elicit a detailed drug history, specifically inquiring about synthetic cannabinoid use. Urine drug immunoassays may be unreliable and in this case did not detect synthetic cannabinoids.
authors.affiliation: Department of Emergency Medicine, Drexel University College of Medicine, Philadelphia, PA, USA, rita.mckeever@drexelmed.edu.
authors.forename: Rita G
authors.initials: RG
authors.lastname: McKeever
authors.forename: David
authors.initials: D
authors.lastname: Vearrier
authors.forename: Dorian
authors.initials: D
authors.lastname: Jacobs
authors.forename: Gregory
authors.initials: G
authors.lastname: LaSala
authors.forename: Jolene
authors.initials: J
authors.lastname: Okaneku
authors.forename: Michael I
authors.initials: MI
authors.lastname: Greenberg
mesh_terms: D000280:Administration, Inhalation; D000293:Adolescent; D000788:Angina Pectoris, Variant / Q000139:chemically induced* / Q000175:diagnosis / Q000209:etiology / Q000628:therapy; D002186:Cannabinoids / Q000008:administration & dosage / Q000633:toxicity* / Q000652:urine; D002637:Chest Pain / Q000209:etiology; D003131:Combined Modality Therapy; D015198:Designer Drugs / Q000008:administration & dosage / Q000633:toxicity*; D003937:Diagnosis, Differential; D004562:Electrocardiography / Q000187:drug effects; D005188:False Negative Reactions; D006801:Humans; D013287:Illicit Drugs / Q000633:toxicity* / Q000652:urine; D007118:Immunoassay; D008297:Male; D009203:Myocardial Infarction / Q000139:chemically induced* / Q000175:diagnosis / Q000209:etiology / Q000628:therapy; D057566:Self Report; D015813:Substance Abuse Detection; D019966:Substance-Related Disorders / Q000503:physiopathology* / Q000628:therapy / Q000652:urine; D066007:Toxicokinetics; D016896:Treatment Outcome
chemical_list: D002186:Cannabinoids; D015198:Designer Drugs; D013287:Illicit Drugs; C569461:cannabinoid K2