title: Acute myocardial infarction, associated with the use of a synthetic adamantyl-cannabinoid: a case report.
abstract: BACKGROUND
  "Legal highs" are novel psychoactive substances that have evaded statutory control. Synthetic cannabinoid compounds with adamantane moieties have recently been identified, which have high potency at target receptors and are undetectable on conventional toxicology testing. However, little is known about any harmful effects, and their potential to cause serious ill health. We describe a case of myocardial infarction following the use of this class of drug.
  
  
  METHODS
  We report the case of a 39-year-old man admitted after an out-of-hospital cardiac arrest, in whom ECG and elevated cardiac enzymes confirmed ST-elevation myocardial infarction. Normal coronary perfusion was restored after thrombectomy and coronary artery stenting. In the hours preceding his admission, the patient is known to have consumed the legal high product "Black Mamba". Subsequent urine testing confirmed the presence of an adamantyl-group synthetic cannabinoid, whilst cannabis, cocaine, amphetamines and other drugs of abuse were not detected.
  
  
  CONCLUSIONS
  The use of legal highs is being increasingly recognised, but the chemical compositions and physiological effects of these drugs are poorly characterised and are continually changing. Synthetic cannabinoids, rarely identified on toxicological testing, can be linked to serious adverse cardiovascular events. This case highlights the importance of testing for novel psychoactive compounds, and recognising their potential to cause life-threatening conditions.
authors.affiliation: Department of Cardiology, Sandwell and West Birmingham Hospitals NHS Trust, Dudley Road, Birmingham, B18 7QH, UK. graham.mcilroy@doctors.org.uk.
authors.forename: Graham
authors.initials: G
authors.lastname: McIlroy
authors.affiliation: Department of Clinical Biochemistry, Sandwell and West Birmingham Hospitals NHS Trust, Dudley Road, Birmingham, B18 7QH, UK. loretta.ford@nhs.net.
authors.forename: Loretta
authors.initials: L
authors.lastname: Ford
authors.affiliation: Department of Cardiology, Sandwell and West Birmingham Hospitals NHS Trust, Dudley Road, Birmingham, B18 7QH, UK. jawad.khan1@nhs.net.
authors.forename: Jawad M
authors.initials: JM
authors.lastname: Khan
mesh_terms: D000218:Adamantane / Q000008:administration & dosage / Q000633:toxicity* / Q000652:urine; D000280:Administration, Inhalation; D000328:Adult; D002186:Cannabinoids / Q000008:administration & dosage / Q000633:toxicity* / Q000652:urine; D015198:Designer Drugs / Q000008:administration & dosage / Q000032:analysis / Q000633:toxicity*; D003937:Diagnosis, Differential; D004632:Emergency Medical Services; D004739:England; D006801:Humans; D058545:Inhalant Abuse / Q000175:diagnosis / Q000503:physiopathology* / Q000652:urine; D008297:Male; D009203:Myocardial Infarction / Q000209:etiology* / Q000628:therapy; D011619:Psychotropic Drugs / Q000008:administration & dosage / Q000633:toxicity* / Q000652:urine; D066007:Toxicokinetics; D016896:Treatment Outcome
chemical_list: D002186:Cannabinoids; D015198:Designer Drugs; D011619:Psychotropic Drugs; D000218:Adamantane