A man in his mid-30′s gets brought by ambulance with palpitations. His mom arrived right behind the ambulance.
The patient was obviously anxious and was dripping with sweat. We hooked him up to the monitor and he’s in SVT up to the 160′s.
No medical problems. Occasional alcohol. Smokes half a pack a day. No drugs. This same thing happened to him a year or so ago, the doctors did a bunch of tests and didn’t find anything.
Nothing out of the ordinary on his physical examination.
We ordered some labs and gave him an IV calcium channel blocker. His heart rate came down to the low 100s. He still appeared anxious, so I have him a little bit of a benzo to calm him down. Soon he was feeling better.
His labs came back normal – everything except his positive marijuana screen. He’s lying because he had a bad reaction to his marijuana and we just did a ton of medical testing on him. I grabbed the drug screen result off the chart and headed into the room to confront him about the lying and the drug use.
I opened the door and he and mom were watching TV.
“I got your lab tests back.”
“Listen. Um. I figured I may as well tell you since you’re my doctor and all – I was smoking a blunt of hash at my friend’s house about a half hour before this happened. You think that may have caused my heart to go so out of control?”
“Ummm. Yeah, I do. I had the lab results right here. I was going to ask that your mom leave the room before telling you about your positive drug screen.”
“It’s OK, she knows.”
“Well then she can remind you that you need to stop using drugs.” Mom nodded her head up and down.
“Yeah, I’ve had people tell me that before.”
“You can go home now. Just stay away from the dope,” I said as I left to go finish his discharge instructions.
Then the patient yelled “Hey doc!”
I turned around.
“You’re not going to call the police about this are you?”
“You mean about you using the drugs?”
“Yeah.”
“No. We don’t call the police for drug use …” I hesitated for a second, thinking about whether I should say what else was on my mind. Heck with it. I’m not going to beat around the bush with this guy.
“… but I can give your mom some numbers for funeral homes and some cool sayings to put on your tombstone if you do it again.”
The patient just sat quietly on the stretcher and stared at his toes. The rhythmic beeping of the cardiac monitor and the muffled sounds of a child crying in a room down the hall were all that was audible.
I was standing at the desk finishing writing up his chart as they left the room and headed toward the exit. His mom patted me on the back and whispered “Thank You” in my ear as they were leaving.
Hopefully one type of blunt will stop the other type of blunt.
I don’t understand…no one has ever told me that there are any side effects from smoking marijuana. It could kill you?? I’m so confused (and I’m not joking)! Please explain.
it’s from the tachycardia. the pot caused his heart rate to skyrocket to 160 beats per minute, a rate at which it simply doesn’t have much time to refill and pump blood effectively. that is potentially life threatening.
Would that have been due to a specific health problem that this patient had?
I thought that there were no deaths due to marijuana: http://drugwarfacts.org/cms/?q=node/30
Why not use Adenosine if it was reentrant SVT? Also, I have never seen marijuana induced arrhythmias – just sinus tach.
Cocaine, now that is a different story….
Reminds me of the old ad with Gary Coleman: “Why do ou think they call it dope?”
[...] This post was mentioned on Twitter by ahmad ghaus, JillofAllTrades,MD. JillofAllTrades,MD said: lovely story (via @rlbates) From WhiteCoat's Call Room >> Blunt-ness http://bit.ly/bUJxto [...]
You never know what the dealer has cut it with, or whether it’s supposed to have extra drugs in it to add a ‘kick’.
You won’t believe this WhiteCoat but today I took Step 1 and right before I went in there I went to check out one of my favorite medical blogs (yours) and read this post. I had the same exact scenario on my exam and probably would have gotten the answer wrong if not for this. Thanks!
Good for you!
If he’s an addict ..doubtful it would help ..*but* you never know. Sometimes the right word at the right time does make a difference. At the very least you planted a seed for thought. And at least you helped Mom feel validated. No doubt she’s mentioned it if she was concerned.
adenosine is overrated for many ‘stable’ cases. It is uncomfortable for patients. I am using it less and less.
and who perpetuated the myth and believes that marijuana is harmless?
I am still trying to figure out the mechanism that causes the cause the heart to go flingy flingy…. I mean cocaine… makes sense…I just always thought the maryjan makes things go ssslllooowwweeerrrr….um slower. hm
Oh..so of course..if I actually googled the side effects of pot..I would have understood that when you chill out…your blood pressure goes down…your heart rates goes up! Yeah. I get it…
But seriously, if pot growers and all there hydroponic trickery got together to grow like…FOOD..maybe there would not be people starving…anyways…