Fatal Cannabis-Associated Cardiovascular Toxicity Following High-Potency Cannabis Use: An Integrated Clinicopathologic Investigation.

Cannabis has been associated with acute cardiovascular complications, including ventricular arrhythmias and myocardial infarction, particularly in otherwise healthy young adults. We report the death of a 28-year-old man who suffered from witnessed ventricular fibrillation while smoking a legally purchased cannabis product labeled as containing 29.9% Δ9-tetrahydrocannabinol (Δ9-THC). Sustained return of spontaneous circulation was achieved after ∼50 minutes of resuscitation. Despite intensive care, severe hypoxic-ischemic encephalopathy developed, and life support was withdrawn 6 days later. Serial ECGs demonstrated evolving ischemic abnormalities accompanied by a dynamic rise in cardiac biomarkers. Autopsy revealed a structurally normal heart with widely patent coronary arteries and patchy acute subendocardial myocardial injury/infarction. Antemortem toxicology demonstrated Δ9-THC and 11-nor-9-carboxy-Δ9-tetrahydrocannabinol, confirming cannabis exposure, while comprehensive cardiac genetic testing identified no pathogenic or likely pathogenic variants. The integrated clinical, electrocardiographic, toxicological, pathologic, and genetic findings support acute cannabis-associated cardiovascular toxicity occurring in close temporal association with high-potency cannabis use. Transient myocardial ischemia secondary to coronary vasospasm is favored, although primary ventricular arrhythmia with secondary global ischemia-reperfusion injury cannot be excluded retrospectively. This case highlights the importance of comprehensive clinicopathologic investigation when evaluating sudden cardiovascular collapse following cannabis exposure.