From the Guidelines
Management of tachycardia associated with marijuana use primarily involves supportive care and reassurance as the condition is typically self-limiting. First, discontinue marijuana use immediately. For mild to moderate tachycardia, patients should rest in a calm environment, practice deep breathing techniques, and stay hydrated. Benzodiazepines such as lorazepam (0.5-2 mg orally or IV) or diazepam (5-10 mg orally) may be used for significant anxiety or sympathetic activation, as noted in the context of cannabis use and its effects on the nervous system 1. Beta-blockers like metoprolol (25-50 mg orally) can be considered for persistent tachycardia, but should be used cautiously due to potential interaction with marijuana's cardiovascular effects, including beta-adrenergic-mediated tachycardia with acute use possibly associated with a greater incidence of myocardial ischaemia in at-risk individuals 1. Avoid stimulants including caffeine. Monitor vital signs until heart rate normalizes, typically within 1-3 hours after acute intoxication. Marijuana-induced tachycardia occurs because THC activates the sympathetic nervous system while inhibiting parasympathetic activity, leading to increased heart rate. In patients with underlying cardiovascular disease, more careful monitoring may be necessary, and if tachycardia is severe or accompanied by chest pain, hypotension, or altered mental status, emergency medical evaluation is warranted, considering the potential risks associated with cannabis and cannabinoids in adults, including tachycardia and orthostatic hypotension 1. Key considerations in management include:
- Discontinuation of marijuana use
- Supportive care
- Monitoring for potential complications, especially in those with pre-existing cardiovascular conditions
- Judicious use of medications like benzodiazepines and beta-blockers
- Awareness of the potential for hepatotoxicity with CBD use, although this is more relevant to long-term use rather than acute management of tachycardia 1.
From the Research
Management of Tachycardia Associated with Marijuana Use
- The management of tachycardia associated with marijuana use involves addressing the underlying cause of the condition, which is the use of marijuana 2, 3.
- Clinicians and nurses should inquire about acute and chronic cannabis use in their patients presenting with tachycardia, bradycardia, dysrhythmia, chest pain, and/or unexplained syncope 2.
- Patients who use cannabis should be educated on the potential deleterious association between cannabis use and cardiac dysrhythmias, especially those with underlying cardiac disease or risk factors 2.
- In cases of cannabis-induced tachycardia, treatment may involve beta-blockers, as seen in a case study where a patient successfully stopped smoking cannabis and was treated with beta-blockers, resulting in no further episodes of arrhythmia 3.
Cardiac Arrhythmias Associated with Marijuana Use
- Cannabis use has been associated with various cardiac arrhythmias, including atrial fibrillation, atrial flutter, atrioventricular block, premature ventricular contractions, premature atrial contractions, ventricular tachycardia, and ventricular fibrillation 2, 3, 4.
- The use of marijuana has also been linked to increased risk of acute coronary syndrome, which can manifest as chest pain, angina pectoris, unstable angina, myocardial infarction, myocardial ischemia, and cardiac arrest 5.
- The relationship between cannabis and cardiovascular disease is complex, and while cannabinoids may have therapeutic potential, they can also cause substantial adverse cardiovascular events 6.
Importance of Education and Awareness
- Education and awareness about the potential risks of cannabis use on cardiac health are crucial, especially for patients with underlying cardiac disease or risk factors 2, 6.
- Clinicians should be aware of the potential for cannabis use to contribute to cardiac arrhythmias and other cardiovascular complications, and should inquire about cannabis use in patients presenting with these conditions 2, 3, 5.