title: Synthetic Cannabinoids and Their Effects on the Cardiovascular System.
abstract: BACKGROUND
  In the past couple of years, there has been an outbreak of synthetic cannabinoid (SC) use in major cities in the United States. Patients can present with various symptoms affecting the central nervous and cardiovascular systems. The effects of endocannabinoid on contractility and Ca(2+) signaling have been shown through both cannabinoid receptors and a direct effect on ion channels. These effects result in abnormalities in ionotropy, chronotropy, and conduction.
  
  
  METHODS
  Here we report on two cases of SC abuse and abnormalities in the cardiovascular system. These cases raise concerns about the adverse effects of SCs and the possibility of QTc prolongation and subsequent complications when using antipsychotic medication in the presence of SC abuse. WHY SHOULD AN EMERGENCY PHYSICIAN BE AWARE OF THIS?: Given the rise in SC use and the potential effect on the cardiovascular system, physicians need to be mindful of potential cardiac complications, such as QTc prolongation and torsade de pointe, especially when administering medications that have the potential to cause QTc prolongation.
authors.affiliation: Department of Emergency Medicine, New York Medical College at Metropolitan Hospital Center, New York, New York.
authors.forename: Jonathan
authors.initials: J
authors.lastname: Von Der Haar
authors.affiliation: Department of Internal Medicine, New York Medical College at Metropolitan Hospital Center, New York, New York.
authors.forename: Soheila
authors.initials: S
authors.lastname: Talebi
authors.affiliation: Department of Emergency Medicine, New York Medical College at Metropolitan Hospital Center, New York, New York.
authors.forename: Farzaneh
authors.initials: F
authors.lastname: Ghobadi
authors.affiliation: Department of Psychiatry, New York Medical College at Metropolitan Hospital Center, New York, New York.
authors.forename: Shailinder
authors.initials: S
authors.lastname: Singh
authors.affiliation: Department of Emergency Medicine, New York Medical College at Metropolitan Hospital Center, New York, New York.
authors.forename: Roger
authors.initials: R
authors.lastname: Chirurgi
authors.affiliation: Department of Emergency Medicine, New York Medical College at Metropolitan Hospital Center, New York, New York.
authors.forename: Pingle
authors.initials: P
authors.lastname: Rajeswari
authors.affiliation: Department of Emergency Medicine, New York Medical College at Metropolitan Hospital Center, New York, New York.
authors.forename: Hossein
authors.initials: H
authors.lastname: Kalantari
authors.affiliation: Department of Emergency Medicine, New York Medical College at Metropolitan Hospital Center, New York, New York.
authors.forename: Getaw Worku
authors.initials: GW
authors.lastname: Hassen
mesh_terms: D000328:Adult; D002186:Cannabinoids / Q000009:adverse effects*; D002319:Cardiovascular System / Q000187:drug effects*; D003863:Depression / Q000188:drug therapy*; D017831:Diagnosis, Dual (Psychiatry); D004562:Electrocardiography / Q000187:drug effects; D006801:Humans; D008297:Male; D008875:Middle Aged; D019966:Substance-Related Disorders / Q000503:physiopathology*
chemical_list: D002186:Cannabinoids
keywords: cardiovascular system; synthetic cannabinoids; toxicology