Background
Synthetic cannabinoid use such as "K
2" and "Spice" is popular due to its inability to be detected in a urine drug screen. It is associated with a wide range of myocardial pathologies including obstructive and non-obstructive coronary disease such as Takotsubo cardiomyopathy.
A case report of an emancipated 15-year-old male experiencing Takotsubo cardiomyopathy after using the synthetic cannabinoid "Spice" is presented here.Synthetic cannabinoids act as full agonists and bind to cannabinoid receptors (CB receptors) with a much greater potency compared to natural forms of marijuana. In particular, "Spice" decreases the release of glutamate via the CB receptor type 1 (CB1 receptor) in higher concentrations, which causes mitogen-activated protein kinase (MAPK) activation with substances released in response to stressful environments being experienced in the body. These effects can cause the sympathetic system to become activated by synthetic cannabinoid use, leading to a surge in catecholamines and a change from normal positive inotropy to abnormally-mediated negative inotropy. Use of synthetic cannabinoids can therefore be associated with Takotsubo cardiomyopathy. This case has important implications for additional examination due to the sparse information describing co-occurrence of Takotsubo cardiomyopathy and synthetic cannabinoid use.
