{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,14]],"date-time":"2026-10-14T19:59:18Z","timestamp":1792007958797,"version":"4.4.0"},"reference-count":18,"publisher":"Springer Science and Business Media LLC","issue":"1","license":[{"start":{"date-parts":[[2023,10,25]],"date-time":"2023-10-25T00:00:00Z","timestamp":1698192000000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"},{"start":{"date-parts":[[2023,10,25]],"date-time":"2023-10-25T00:00:00Z","timestamp":1698192000000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"}],"funder":[{"DOI":"10.13039\/501100003500","name":"Universit\u00e0 degli Studi di Padova","doi-asserted-by":"crossref","id":[{"id":"10.13039\/501100003500","id-type":"DOI","asserted-by":"crossref"}]}],"content-domain":{"domain":["link.springer.com"],"crossmark-restriction":false},"short-container-title":["BMC Cardiovasc Disord"],"abstract":"<jats:title>Abstract<\/jats:title><jats:sec>\n                <jats:title>Background<\/jats:title>\n                <jats:p>Cannabis is the most consumed drug worldwide and number of users is increasing, particularly among youth. Moreover, cannabis potential therapeutic properties have renewed interest to make it available as a treatment for a variety of conditions. Albeit rarely, cannabis consumption has been associated with cardiovascular diseases such as arrhythmias, myocardial infarction (MI) and potentially sudden death.<\/jats:p>\n              <\/jats:sec><jats:sec>\n                <jats:title>Case presentation<\/jats:title>\n                <jats:p>A 24-year-old woman presented to the emergency department sent by her cardiologist because of a recent finding of a 16 seconds asystole on the implantable loop recorder (ILR) she implanted 7 months before for recurrent syncopes. She declared that she is a heavy cannabis user (at least 5 cannabis-cigarette per day, not mixed up with tobacco, for no less than 12 years) and all syncopes occurred shortly after cannabis consumption. After a collective discussion with the heart team, syncope unit, electrophysiologists and toxicologist, we decided to implant a dual chamber pacemaker with a rate response algorithm due to the high risk of trauma of the syncopal episodes. 24 months follow-up period was uneventful.<\/jats:p>\n              <\/jats:sec><jats:sec>\n                <jats:title>Conclusions<\/jats:title>\n                <jats:p>Cannabis cardiovascular effects are not well known and, although rare, among these we find ischemic episodes, tachyarrhythmias, symptomatic sinus bradycardia, sinus arrest, ventricular asystole and possibly death. Because of cannabis growing consumption both for medical and recreational purpose, cardiovascular diseases associated with cannabis use may become more and more frequent. In the light of the poor literature, we believe that cannabis may produce opposite adverse effects depending on the duration of the habit. Acute administration increases sympathetic tone and reduces parasympathetic tone; conversely, with chronic intake an opposite effect is observed: repetitive dosing decreases sympathetic activity and increases parasympathetic activity. Clinicians should be aware of the increased risk of cardiovascular complications associated with cannabis use and should investigate its consumption especially in young patients presenting with cardiac dysrhythmias.<\/jats:p>\n              <\/jats:sec>","DOI":"10.1186\/s12872-023-03566-4","type":"journal-article","created":{"date-parts":[[2023,10,25]],"date-time":"2023-10-25T01:02:18Z","timestamp":1698195738000},"update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":8,"title":["Syncope and Cannabis: hypervagotonia from chronic abuse? A case report and literature review"],"prefix":"10.1186","volume":"23","author":[{"given":"Marco","family":"Licciardi","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Elena","family":"Utzeri","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Maria Francesca","family":"Marchetti","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Vincenzo","family":"Nissardi","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Giovanni","family":"Cecchetto","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Massimo","family":"Montisci","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Roberta","family":"Montisci","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"297","published-online":{"date-parts":[[2023,10,25]]},"reference":[{"key":"3566_CR1","unstructured":"World Drug Report 2021 (United Nations publication, Sales No. E.21.XI.8). Drug market trend: Cannabis Opioids. World Drug Report 2021; www.unodc.org\/unodc\/en\/data-and-analysis\/wdr2021.html."},{"key":"3566_CR2","doi-asserted-by":"publisher","first-page":"e131","DOI":"10.1161\/CIR.0000000000000883","volume":"142","author":"RL Page II","year":"2020","unstructured":"Page RL II, Allen LA, Kloner RA, et al. Medical marijuana, recreational cannabis, and cardiovascular health: a scientific statement from the American Heart Association. Circulation. 2020;142:e131\u201352. https:\/\/doi.org\/10.1161\/CIR.0000000000000883.","journal-title":"Circulation"},{"issue":"1","key":"3566_CR3","doi-asserted-by":"publisher","first-page":"S163","DOI":"10.1038\/sj.bjp.0706406","volume":"147","author":"RG Pertwee","year":"2006","unstructured":"Pertwee RG. Cannabinoid pharmacology: the first 66 years. Br J Pharmacol. 2006;147(1):S163-71. https:\/\/doi.org\/10.1038\/sj.bjp.0706406.","journal-title":"Br J Pharmacol"},{"issue":"9","key":"3566_CR4","doi-asserted-by":"publisher","first-page":"861","DOI":"10.1080\/15563650.2020.1743847","volume":"58","author":"JR Richards","year":"2020","unstructured":"Richards JR, Blohm E, Toles KA, Jarman AF, Ely DF, Elder JW. The association of cannabis use and cardiac dysrhythmias: a systematic review. Clin Toxicol (Phila). 2020;58(9):861\u20139. https:\/\/doi.org\/10.1080\/15563650.2020.1743847.","journal-title":"Clin Toxicol (Phila)"},{"issue":"1","key":"3566_CR5","doi-asserted-by":"publisher","first-page":"3","DOI":"10.1016\/j.amjms.2017.03.027","volume":"355","author":"MR Heckle","year":"2018","unstructured":"Heckle MR, Nayyar M, Sinclair SE, Weber KT. Cannabinoids and symptomatic bradycardia. Am J Med Sci. 2018;355(1):3\u20135. https:\/\/doi.org\/10.1016\/j.amjms.2017.03.027.","journal-title":"Am J Med Sci"},{"issue":"1","key":"3566_CR6","doi-asserted-by":"publisher","first-page":"15","DOI":"10.1016\/j.jelectrocard.2015.10.003","volume":"49","author":"D Brancheau","year":"2016","unstructured":"Brancheau D, Blanco J, Gholkar G, et al. Cannabis induced asystole. J Electrocardiol. 2016;49(1):15\u20137. https:\/\/doi.org\/10.1016\/j.jelectrocard.2015.10.003.","journal-title":"J Electrocardiol"},{"issue":"3","key":"3566_CR7","doi-asserted-by":"publisher","first-page":"371","DOI":"10.1097\/00007611-198103000-00035","volume":"74","author":"D Akins","year":"1981","unstructured":"Akins D, Awdeh MR. Marijuana and second-degree AV block. South Med J. 1981;74(3):371\u20133. https:\/\/doi.org\/10.1097\/00007611-198103000-00035.","journal-title":"South Med J"},{"issue":"S1","key":"3566_CR8","doi-asserted-by":"publisher","first-page":"58S","DOI":"10.1002\/j.1552-4604.2002.tb06004.x","volume":"42","author":"RT Jones","year":"2002","unstructured":"Jones RT. Cardiovascular system effects of marijuana. J Clin Pharmacol. 2002;42(S1):58S-63S. https:\/\/doi.org\/10.1002\/j.1552-4604.2002.tb06004.x.","journal-title":"J Clin Pharmacol"},{"issue":"S1","key":"3566_CR9","doi-asserted-by":"publisher","first-page":"214S","DOI":"10.1002\/j.1552-4604.1981.tb02598.x","volume":"21","author":"NL Benowitz","year":"1981","unstructured":"Benowitz NL, Jones RT. Cardiovascular and metabolic considerations in prolonged cannabinoid administration in man. J Clin Pharmacol. 1981;21(S1):214S-223S. https:\/\/doi.org\/10.1002\/j.1552-4604.1981.tb02598.x.","journal-title":"J Clin Pharmacol"},{"key":"3566_CR10","doi-asserted-by":"publisher","first-page":"141","DOI":"10.1016\/j.nbd.2013.06.016","volume":"59","author":"M Mecha","year":"2013","unstructured":"Mecha M, Feli\u00fa A, I\u00f1igo PM, Mestre L, Carrillo-Salinas FJ, Guaza C. Cannabidiol provides long-lasting protection against the deleterious effects of inflammation in a viral model of multiple sclerosis: a role for A2A receptors. Neurobiol Dis. 2013;59:141\u201350. https:\/\/doi.org\/10.1016\/j.nbd.2013.06.016.","journal-title":"Neurobiol Dis"},{"issue":"13","key":"3566_CR11","doi-asserted-by":"publisher","first-page":"1435","DOI":"10.1007\/s40265-019-01171-4","volume":"79","author":"V Franco","year":"2019","unstructured":"Franco V, Perucca E. Pharmacological and therapeutic properties of cannabidiol for epilepsy. Drugs. 2019;79(13):1435\u201354. https:\/\/doi.org\/10.1007\/s40265-019-01171-4.","journal-title":"Drugs"},{"issue":"21","key":"3566_CR12","doi-asserted-by":"publisher","first-page":"1883","DOI":"10.1093\/eurheartj\/ehy037","volume":"39","author":"M Brignole","year":"2018","unstructured":"Brignole M, Moya A, de Lange FJ, et al. ESC Scientific Document Group 2018 ESC Guidelines for the diagnosis and management of syncope. Eur Heart J. 2018;39(21):1883\u2013948. https:\/\/doi.org\/10.1093\/eurheartj\/ehy037.","journal-title":"Eur Heart J"},{"issue":"6","key":"3566_CR13","doi-asserted-by":"publisher","first-page":"740","DOI":"10.1016\/S0002-8703(77)80215-9","volume":"94","author":"RH Miller","year":"1977","unstructured":"Miller RH, Dhingra RC, Kanakis C Jr, Amat-y-Leon F, Rosen KM. The electrophysiological effects of delta-9-tetrahydrocannabinol (cannabis) on cardiac conduction in man. Am Heart J. 1977;94(6):740\u20137. https:\/\/doi.org\/10.1016\/S0002-8703(77)80215-9.","journal-title":"Am Heart J"},{"issue":"5","key":"3566_CR14","doi-asserted-by":"publisher","first-page":"344","DOI":"10.1016\/j.carpath.2007.05.005","volume":"17","author":"M Montisci","year":"2008","unstructured":"Montisci M, Thiene G, Ferrara SD, Basso C. Cannabis and cocaine: a lethal cocktail triggering coronary sudden death. Cardiovasc Pathol. 2008;17(5):344\u20136. https:\/\/doi.org\/10.1016\/j.carpath.2007.05.005.","journal-title":"Cardiovasc Pathol"},{"issue":"5","key":"3566_CR15","doi-asserted-by":"publisher","first-page":"516","DOI":"10.1016\/j.echo.2010.03.005","volume":"23","author":"R Montisci","year":"2010","unstructured":"Montisci R, Cecchetto G, Ruscazio M, et al. Early myocardial dysfunction after chronic use of anabolic androgenic steroids: combined pulsed-wave tissue Doppler imaging and ultrasonic integrated backscatter cyclic variations analysis. J Am Soc Echocardiogr. 2010;23(5):516\u201322. https:\/\/doi.org\/10.1016\/j.echo.2010.03.005.","journal-title":"J Am Soc Echocardiogr"},{"key":"3566_CR16","doi-asserted-by":"publisher","first-page":"67","DOI":"10.1007\/978-3-030-57369-0_5","volume":"1264","author":"D Feingold","year":"2021","unstructured":"Feingold D, Weinstein A. Cannabis and Depression. Adv Exp Med Biol. 2021;1264:67\u201380. https:\/\/doi.org\/10.1007\/978-3-030-57369-0_5.","journal-title":"Adv Exp Med Biol"},{"key":"3566_CR17","doi-asserted-by":"publisher","first-page":"26","DOI":"10.2174\/1745017901814010026","volume":"14","author":"F Sancassiani","year":"2018","unstructured":"Sancassiani F, Carta MG, Montisci R, et al. Takotsubo Syndrome is associated with mood disorders and Antidepressants use, not with anxiety and impairment of quality of life due to the psychiatric disorder. Clin Pract Epidemiol Ment Health. 2018;14:26\u201332. https:\/\/doi.org\/10.2174\/1745017901814010026.","journal-title":"Clin Pract Epidemiol Ment Health"},{"issue":"4","key":"3566_CR18","doi-asserted-by":"publisher","first-page":"493","DOI":"10.1097\/FTD.0b013e3182892d11","volume":"35","author":"D Favretto","year":"2013","unstructured":"Favretto D, Stocchero G, Nalesso A, et al. Monitoring haloperidol exposure in body fluids and hair of children by liquid chromatography-high-resolution mass spectrometry. Drug Monit. 2013;35(4):493\u2013501. https:\/\/doi.org\/10.1097\/FTD.0b013e3182892d11.","journal-title":"Drug Monit"}],"container-title":["BMC Cardiovascular Disorders"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/link.springer.com\/content\/pdf\/10.1186\/s12872-023-03566-4.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/link.springer.com\/article\/10.1186\/s12872-023-03566-4\/fulltext.html","content-type":"text\/html","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/link.springer.com\/content\/pdf\/10.1186\/s12872-023-03566-4.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2023,11,17]],"date-time":"2023-11-17T15:14:22Z","timestamp":1700234062000},"score":1,"resource":{"primary":{"URL":"https:\/\/bmccardiovascdisord.biomedcentral.com\/articles\/10.1186\/s12872-023-03566-4"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2023,10,25]]},"references-count":18,"journal-issue":{"issue":"1","published-online":{"date-parts":[[2023,12]]}},"alternative-id":["3566"],"URL":"https:\/\/doi.org\/10.1186\/s12872-023-03566-4","relation":{},"ISSN":["1471-2261"],"issn-type":[{"value":"1471-2261","type":"electronic"}],"subject":[],"published":{"date-parts":[[2023,10,25]]},"assertion":[{"value":"12 April 2023","order":1,"name":"received","label":"Received","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"17 October 2023","order":2,"name":"accepted","label":"Accepted","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"25 October 2023","order":3,"name":"first_online","label":"First Online","group":{"name":"ArticleHistory","label":"Article History"}},{"order":1,"name":"Ethics","group":{"name":"EthicsHeading","label":"Declarations"}},{"value":"Ethics approval was not sought as this report contains a single case report for which patient consent was obtained.","order":2,"name":"Ethics","group":{"name":"EthicsHeading","label":"Ethics approval and consent to participate"}},{"value":"M.L. collected the clinical data and wrote the manuscript, E.U. and M.F.M. and V.N. collected the clinical data and contribute to write the manuscript. M.M. and G.C. reviewed and revised the manuscript. M.M. and G.C. contributed equally to this article. R.M. devised the manuscript and contribute to wrote and reviewed the manuscript. All authors have read and agreed to the published version of the manuscript.","order":3,"name":"Ethics","group":{"name":"EthicsHeading","label":"Consent for publication"}},{"value":"The authors declare no competing interests.","order":4,"name":"Ethics","group":{"name":"EthicsHeading","label":"Competing interests"}}],"article-number":"518"}}