humulene and Hypotension

The United States has recently undergone increases in the legalization and use of marijuana. There have been previous reports on the association of cannabis use and myocardial dysfunction, however, few on the association with acute stress cardiomyopathy and cardiogenic shock.. This is a case of a 58-year-old female with a history of inhaled cannabis use, no history of diabetes, and no known history of cardiac disease, that illustrates an association between cannabis use and the recurrent development of stress cardiomyopathy and cardiogenic shock. A review of medical records was performed from two hospitalizations and subsequent outpatient follow-up for similar presentations 6 years apart and review of literature regarding cannabis use and its association with cardiac dysfunction. In separate hospitalizations, the patient presented with clinical findings of cardiogenic shock, severe left ventricular dysfunction with morphologic features of stress cardiomyopathy, and normal coronary angiography. Laboratory results included elevated cardiac biomarkers and urine tetrahydrocannabinol levels > 300 ng/mL. The patient required intensive cardiovascular support, but recovered with normal cardiac function after each event. WHY SHOULD AN EMERGENCY PHYSICIAN BE AWARE OF THIS?: As use of cannabis becomes more prevalent, it will be important for physicians to recognize the potential association of cannabis use and acute myocardial dysfunction, and how early treatment may contribute to salutary outcomes.

Topics: Cannabis; Cardiomyopathies; Electrocardiography; Female; Humans; Hypotension; Intra-Aortic Balloon Pumping; Marijuana Abuse; Middle Aged; Recurrence; Shock

The psychoactive properties of cannabinoids, the biologically active constituents of the marijuana plant, have long been recognized. Recent research has revealed that cannabinoids elicit not only neurobehavioral, and immunological, but also profound cardiovascular effects. Similar effects can be elicited by the endogenous ligand arachidonyl ethanolamine (anandamide) and 2-arachidonoyl-glycerol. The biological effects of cannabinoids are mediated by specific receptors. Two cannabinoid receptors have been identified so far: CB1-receptors are expressed by different cells of the brain and in peripheral tissues, while CB2-receptors were found almost exclusively in immune cells. Through the use of a selective CB1 receptor antagonist and CB1 receptor-knockout mice the hypotensive and bradycardic effects of cannabinoids in rodents could be attributed to activation of peripheral CB1 receptors. In hemodynamic studies using the radioactive microsphere technique in anesthetized rats, cannabinoids were found to be potent CB1-receptor dependent vasodilators in the coronary and cerebrovascular beds. Recent findings implicate the endogenous cannabinoid system in the pathomechanism of haemorrhagic, endotoxic and cardiogenic shock. Finally, there is evidence that the extreme mesenteric vasodilation, portal hypertension and systemic hypotension present in advanced liver cirrhosis are also mediated by the endocannabinoid system. These exciting, recent research developments indicate that the endogenous cannabinoid system plays an important role in cardiovascular regulation, and pharmacological manipulation of this system may offer novel therapeutic approaches in a variety of pathological conditions.

Topics: Animals; Cannabinoid Receptor Modulators; Cannabinoids; Cannabis; Cardiovascular System; Humans; Hypertension, Portal; Hypotension; Liver Cirrhosis; Receptors, Cannabinoid; Receptors, Drug; Shock, Cardiogenic; Sympatholytics; Vasodilation

Topics: Animals; Antihypertensive Agents; Barbiturates; Behavior, Animal; Blood Pressure; Body Temperature Regulation; Cannabis; Cats; Central Nervous System; Dogs; Dronabinol; Drug Combinations; Drug Interactions; Drug Synergism; Drug Tolerance; Haplorhini; Heart Rate; Hypotension; Hypothermia; Macaca; Mice; Reserpine; Respiration; Sleep; Structure-Activity Relationship; Time Factors

To determine whether plant-derived cannabis medicinal extracts (CME) can alleviate neurogenic symptoms unresponsive to standard treatment, and to quantify adverse effects.. A consecutive series of double-blind, randomized, placebo-controlled single-patient cross-over trials with two-week treatment periods.. Patients attended as outpatients, but took the CME at home.. Twenty-four patients with multiple sclerosis (18), spinal cord injury (4), brachial plexus damage (1), and limb amputation due to neurofibromatosis (1).. Whole-plant extracts of delta-9-tetrahydrocannabinol (THC), cannabidiol (CBD), 1:1 CBD:THC, or matched placebo were self-administered by sublingual spray at doses determined by titration against symptom relief or unwanted effects within the range of 2.5-120 mg/24 hours. Measures used: Patients recorded symptom, well-being and intoxication scores on a daily basis using visual analogue scales. At the end of each two-week period an observer rated severity and frequency of symptoms on numerical rating scales, administered standard measures of disability (Barthel Index), mood and cognition, and recorded adverse events.. Pain relief associated with both THC and CBD was significantly superior to placebo. Impaired bladder control, muscle spasms and spasticity were improved by CME in some patients with these symptoms. Three patients had transient hypotension and intoxication with rapid initial dosing of THC-containing CME.. Cannabis medicinal extracts can improve neurogenic symptoms unresponsive to standard treatments. Unwanted effects are predictable and generally well tolerated. Larger scale studies are warranted to confirm these findings.

Topics: Administration, Oral; Analgesics, Non-Narcotic; Cannabidiol; Cannabis; Cross-Over Studies; Double-Blind Method; Dronabinol; Humans; Hypotension; Muscle Spasticity; Nervous System Diseases; Pain; Phytotherapy; Placebos; Plant Preparations; Severity of Illness Index; Spasm; Urination Disorders

Topics: Blood Pressure; Bradycardia; Cannabis; Clinical Trials as Topic; Dronabinol; Headache; Heart Rate; Humans; Hunger; Hypotension; Injections, Intramuscular; Isomerism; Laughter; Male; Methoxamine; Nausea; Phenylephrine; Placebos; Posture; Tachycardia; Thirst; Vision Disorders

To investigate if clinical features associated with acute cannabis intoxication in patients presenting to Emergency Departments for medical assistance differ according to patient age and sex.. We analysed presentations in the Euro-DEN Plus dataset from 2014 to 2019 in which cannabis was the only drug involved (except for alcohol), and age, sex and alcohol co-ingestion had been recorded. Age was considered as categorical (five groups; <20, 20-29, 30-39, 40-49 and ≥50 years), and sex as binary variable (male/female). We evaluated 12 key clinical features recorded during emergency department (ED) care. Risks of presenting with each of these clinical features according to patient age and sex were calculated by logistic regression models, and adjusted for sex, age and alcohol co-ingestion.. 4,268 of 43,633 Euro-DEN presentations (9.8%) fulfilled the inclusion criteria (median age: 26 years (IQR = 20-34), 70% male, 52% co-ingested alcohol). The frequency of clinical features was: anxiety 28%, vomiting 24%, agitation 23%, palpitations 14%, reduced consciousness 13%, acute psychosis 9%, hallucinations 9%, chest pain 7%, headache 6%, hypotension 4%, hypertension 3% and seizures 2%. Patients younger than 20 years more frequently had vomiting (34.7% of cases), reduced consciousness (21.5%), and headache (10.8%); and less frequently acute psychosis (5.5%). Patients older than 49 years more often had hypotension (6.5%) and less frequently vomiting (20%), anxiety (14%), agitation (14%) and reduced consciousness (10%). Males more frequently presented with hypertension (3.7 vs. 1.5%; OR = 2.311, 95%CI = 1.299-3.816), psychosis (10.4 vs 6.3%; 1.948, 1.432-2.430), chest pain (8.1 vs 4.5%; 1.838, 1.390-2.430) and seizures (2.5 vs 1.4%; 1.805, 1.065-3.060), and less frequently with vomiting (21.8 vs 28.2%; 0.793, 0.677-0.930), anxiety (25.4 vs 32.3%; 0.655, 0.561-0.766) and hypotension (2.9 vs 5.8%; 0.485, 0.350-0.671).. The prevalence of some clinical features typically associated with acute cannabis intoxication differed according to age and sex. The causes for these differences should be further investigated in order to better understand the pathophysiology of cannabis-related acute toxicity, and they may be relevant particularly for developing prevention campaigns and for treatment in specific sex and/or age groups.

Topics: Adult; Cannabis; Chest Pain; Emergency Service, Hospital; Ethanol; Female; Headache; Humans; Hypertension; Hypnotics and Sedatives; Hypotension; Male; Middle Aged; Psychotropic Drugs; Seizures; Vomiting

Topics: Adolescent; Amphetamines; Anesthesia; Anesthetics, Inhalation; Cannabis; Depression; Drug Interactions; Female; Humans; Hypotension; Marijuana Smoking; Pain, Postoperative; Paroxetine; Spinal Fusion; Substance Abuse Detection

Two patients who injected marihuana intravenously developed a syndrome of hypotension, renal insufficiency, thrombocytopenia, and rhabdomyolysis. These clinical abnormalities appear to be reversible without residua.

Topics: Acute Kidney Injury; Adult; Cannabis; Humans; Hypotension; Injections, Intravenous; Male; Myoglobinuria; Poisoning; Syndrome; Thrombocytopenia

Topics: Acetylcholine; Animals; Arrhythmias, Cardiac; Blood Pressure; Cannabis; Cardiovascular System; Coma; Guinea Pigs; Histamine; Humans; Hypotension; India; Legislation, Drug; Substance-Related Disorders; United States