Introduction
The usage of synthetic cannabinoids became very popular in young adults. Bonsai is one of the most common cannabinoid in our country. There are several side effects described including convulsion, hypotension, angina pectoris, myocardial infarction(MI). In this case we aimed to report myocardial infarction which is caused by endothelial dissection and thrombus formation immediately after bonsai usage.
Case Description
25-year-old male presented with sudden onset chest pain with a history bonsai usage 90 minutes ago. Electrocardiography demonstrated acute anterior MI. Urgent coronary angiography was performed. Coronary angiography revealed total occlusion of distal left anterior descending artery(LAD) with an intense thrombus located at the proximal LAD. PTCA was performed with a 2.0×20 mm balloon. There was no flow after PTCA. Therefore we used Medtronic export catheter for thrombus aspiration. Thrombus was aspirated and tirofiban was used after PCI. The patient was discharged after 5 days with asetylsalicylic acid, ticagrelor beta blocker and ACEI. One month later control coronary angiography was performed. Control angiography was completely normal. The patient was stopped using asetylsalicylic acid and ticagrelor himself when angiography showed normal coronary anatomy. 5 days later patient was admitted to emergency department with chest pain. ECG revealed biphasic t waves in anterior chest leads. Blood analysis demonstrated the elevated cardiac markers including troponin I. Patient underwent to coronary angiography. Optical coherence tomography(OCT) was performed. OCT clearly demonstrated endothelial dissection and thrombus formation in the proximal LAD. Figure 1 demonstrates the coronary angiograms (images with myocardial infarction and control angiography) and OCT images with second heart attack. Patient successfully treated with intensive medical therapy. We decided to repeat OCT after medical therapy for further treatment including PCI.
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