Introduction
Marijuana and its synthetic forms used for their recreational effects. Bonzai is one of the market name of synthetic cannabinoid (SC) in Turkey. Arrhythmias, myocardial infarction (MI), sudden cardiac death (SCD) were reported with SC usage. Atrial fibrillation (AF) was reported with marijuana use, but has not been reported with SCs use before. CASE: A 23 year-old man was admitted with dyspnea, confusion and palpitation.
His ECG showed atrial fibrillation (AF) 137/minutes (figure 1). The blood pressure was 100/70 mmHg. Oxygen saturation was 60 %, pH was 6.9, serum bicarbonate was 5.5 mEq/L, and potassium level was 6.4 mg/dL. White blood cell (13000) and hemoglobin 18.1 mg/dL were elevated. Nasal O2 started immediately and sodium bicarbonate and naloxone was administered intravenously. The patient received hydration also intravenously. Hyperkalemia was reversed with calcium gluconate, His fried confirmed that he had smoked bonzai for the first time. After treatment the patient has gained conscious and sinus rhythm was restored spontaneously. Serial blood samples were obtained for detection of myocardial damage. Serum creatinine kinase-MB and Troponin I levels were slightly elevated at 72 U/L (normal range: 0–25 U/L), and 1.49 ng/mL (normal: ≤0.06 ng/mL), respectively. Echocardiography test was absolutely normal. Coronary heart disease was rule out by Multi-slice Computed Tomography. He was remained in sinus rhythm and discharged from hospital uneventfully.
DISCUSSION: SCs act as marijuana and can produce euphoria, relaxation, and loss of inhibitions. Increasing heart rate is the most common effect of the marijuana. MI, stroke, and arrhythmias such as ventricular tachycardia and AF have been reported after cannabis use. SCD, MI and stroke was reported with SC usage. There is limited data also arrhythmic effects of SCs; accelerated junctional rhythm, left bundle brunch block, prolonged QT interval were reported. Our case is the first case reported about the atrial fibrillation. One of the accused factor THC and also SC induced arrhythmias is cardiac ischemia; increased heart rate may cause supply demand mismatch and leads arrhythmia. Marijuana may enhance the conduction in atrial perinodal fibers thus it may promote atrial reentry which precipitate AF. Marijuana use also causes an increase in carboxyhemoglobin which also increases ischemia. The management of SCs intoxication usually consist of supportive and symptomatic treatment. The monitoring of heart rhythm and vital parameters must be considered, the serum electrolytes level should also be measured. Unfortunately there is no specific antidote of marijuana or SCs.
