K2—Not the Spice of Life; Synthetic Cannabinoids and ST Elevation Myocardial Infarction: A Case Report. McKeever RG et al. J Med Toxicol 2014 Aug 26 [Epub ahead of print]
Use of synthetic cannabinoids has been associated with a broad range of adverse effects, including tachycardia, hypertension, seizures, psychosis, renal injury, and cyclic vomiting.
This article describes 16-year-old male who presented to hospital with 1 day of substernal chest pressure associated with nausea, vomiting, and dyspnea that started 2 hours after he smoked the synthetic cannabinoid K2. Workup revealed elevated ST segments in the inferolateral leads and elevated troponin that peaked at 8.29 ng/ml (normal 0-0.3 ng/ml). Echocardiogram and cardiac catheterization were unremarkable. Urine drug screen was positive only for opiates and benzodiazepines, both of which the patient received in the hospital before the specimen was obtained. Specimens for additional toxicology tests were sent to an outside lab but never arrived.
The authors claim that this is “the first report of ST-elevation myocardial infarction (STEMI) in the setting of synthetic cannabinoid use without concomitant marijuana use.” To my mind this claim is a bit disingenuous. A 2011 paper by Mir et al — cited in this article — described several teenagers who presented with chest pain and STEMI after smoking K2 but had no history of proximate marijuana use.