Coronary thrombus after cannabis consumption: the important role of intracoronary imaging modalities

Acute myocardial injury in young adults may be a challenging finding. Although coronary artery disease associated with tradi-tional cardiovascular risk factors is possible, other etiologies like the use of recreational drugs, myocarditis, coronary embolism, spontaneous coronary artery dissection or coronary vasospasm should be considered as well. 1 Intracoronary imaging modalities provide diagnostic information added to invasive coronary angiography on coronary lesion features, and are useful to guide percutaneous coronary interventions. 2 This is the case of a 29-year-old male patient with a history of smoking. His family history included coronary artery disease, but not at a young age. The patient presented to the emergency room with signs of acute chest pain radiating down his left arm the morning following a night of heavy alcohol and cannabis consumption. The 12-lead electrocardiogram revealed sinus rhythm, heart rate of 60 beats per minute, and slight and diffuse ST-segment elevation (figure 1A). Blood biochemistry analysis revealed elevated troponin I levels (37.6 ng/mL; normal values < 0.045 ng/mL). The transtho-racic echocardiogram revealed the presence of preserved left ventricular systolic function with normal heart wall motion kinetics, and no evidence of structural heart disease. Although the early suspected diagnosis was myopericarditis