title: Synthetic Cannabinoid Abuse Resulting in ST-Segment Elevation Myocardial Infarction Requiring Percutaneous Coronary Intervention.
abstract: BACKGROUND
  Synthetic cannabinoids (SC) are recreational designer drugs intended to mimic delta-9-tetrahydrocannabinol while surreptitiously circumventing classification by the Drug Enforcement Administration.
  
  
  METHODS
  A 50-year-old black male arrived in the Emergency Department transported by Emergency Medical Services (EMS) for altered mental status after complaining of chest pain associated with smoking SCs. EMS found the patient with an empty foil pack labeled "Scooby Snax Limited Edition Blueberry Potpourri." The patient was somnolent, but became agitated when stimulated and complained of chest pain. Vital signs were blood pressure 87/52 mm Hg and pulse 52 beats/min. The electrocardiogram demonstrated an inferior wall myocardial infarction. Coronary angiography identified an occluded obtuse marginal second branch that was successfully opened with a drug-eluting stent. The patient recovered uneventfully. Urine drug screen was negative for cocaine, and gas chromatography/mass spectrometry testing of the smoked material identified PB-22 and AMB-FUBINACA as the active ingredients. WHY SHOULD AN EMERGENCY PHYSICIAN BE AWARE OF THIS?: Emergency physicians and cardiologists need to be aware that the mechanism of action of synthetic cannabinoids on the endocannabinoid system may result in acute ST-segment elevation myocardial infarction requiring percutaneous coronary intervention.
authors: Department of Emergency Medicine, Drexel University College of Medicine, Philadelphia, Pennsylvania.
authors: Richard J
authors: RJ
authors: Hamilton
authors: Department of Emergency Medicine, Drexel University College of Medicine, Philadelphia, Pennsylvania.
authors: Vadim
authors: V
authors: Keyfes
authors: Department of Cardiology, Drexel University College of Medicine, Philadelphia, Pennsylvania.
authors: Sahil S
authors: SS
authors: Banka
mesh_terms: D002637:Chest Pain / Q000209:etiology; D004636:Emergency Service, Hospital / Q000458:organization & administration; D063388:Endocannabinoids / Q000009:adverse effects*; D006801:Humans; D007022:Hypotension / Q000209:etiology; D007191:Indazoles / Q000009:adverse effects; D007211:Indoles / Q000009:adverse effects; D008297:Male; D008875:Middle Aged; D062645:Percutaneous Coronary Intervention / Q000379:methods*; D011804:Quinolines / Q000009:adverse effects; D000072657:ST Elevation Myocardial Infarction / Q000209:etiology* / Q000601:surgery; D019966:Substance-Related Disorders / Q000175:diagnosis / Q000628:therapy; D014633:Valine / Q000009:adverse effects / Q000031:analogs & derivatives
chemical_list: C000590832:1-pentyl-1H-indole-3-carboxylic acid 8-quinolinyl ester; D063388:Endocannabinoids; D007191:Indazoles; D007211:Indoles; D011804:Quinolines; C000613980:methyl 2-(1-(4-fluorobenzyl)-1H-indazole-3-carboxamido)-3-methylbutanoate; D014633:Valine
keywords: endocannabinoid system; myocardial infarction; percutaneous coronary intervention; synthetic cannabinoids