Plaque erosion causing ST-elevation myocardial infarction after consumption of cannabis and N(2)O in a 27-year old man: a case report

BACKGROUND: The recreational drugs cannabis and nitrous oxide (N(2)O) are known for pro-atherogenic effects and are associated with an elevated risk of myocardial infarction. These cardiovascular effects might be underestimated by the public. Culprit-lesion composition of myocardial infarctions associated with cannabis and N(2)O has been unknown so far. This case report aims to raise the awareness of the adverse cardiovascular effects of cannabis and N(2)O and reports, for the first time, optical coherence tomography (OCT) findings of the culprit lesion. CASE PRESENTATION: This is a case report of a 27-year old man with anterior ST-segment-elevation myocardial infarction (STEMI) after intoxication with cannabis and N(2)O. Coronary angiography and OCT revealed plaque erosion with subsequent subtotal thrombotic occlusion of the left anterior descending artery that was successfully treated with 1 drug-eluting stent. The patient was symptom free at 6 months follow-up and had been able to abstain from drug consumption. CONCLUSIONS: This is the first case to demonstrate the association between cannabis and N(2)O abuse and plaque erosion on OCT in a young man with STEMI. In contrast to smoking, whose adverse effects are well-known, the cardiovascular effects of cannabis and N(2)O might be underestimated. These adverse effects should gain more awareness in the public to prevent early vascular events in young adults. SUPPLEMENTARY INFORMATION: The online version contains supplementary material available at 10.1186/s12872-021-01953-3.