Life-threatening constrictive pericarditis accompanied by synthetic cannabinoid use:A case report and literature review

Rationale:Synthetic cannabinoids are increasingly used as recreational drugs and have been associated with adverse cardiovascular effects.However,reports of synthetic cannabinoids accompanied by constrictive pericarditis are limited.Patient’s concern:A 28-year-old male with a history of synthetic cannabinoid(Bonzai)abuse presented with chest discomfort,dyspnea,and lower extremity edema.Investigations revealed reduced left ventricular ejection fraction,elevated inflammatory markers,low electrocardiogram voltages,and atrial fibrillation.Diagnosis:Chest spiral computerized tomography scan and chest X-ray demonstrated pericardial calcification.Cardiac magnetic resonance imaging and right heart catheterization were done to confirm the possibility of constrictive pericarditis.Based on the patient’s addiction history and exclusion of rheumatologic and infectious causes,it was supposed that constrictive pericarditis and cardiomyopathy may be accompanied by synthetic cannabinoid use.Interventions:The patient received standard medical therapy,including loop diuretics for cardiomyopathy and constrictive pericarditis.Catheter ablation was recommended for his rhythm control,and he was planned for close monitoring of clinical and echocardiographic response and evaluation of the need for surgical pericardiectomy in the future.Outcomes:After 6 months follow-up,echocardiographic exam revealed no significant improvement in ventricular function.However,due to the high surgical risk,the patient’s poor compliance,and the continuation of drug abuse,he was not a good candidate for surgery according to our heart team’s decision.Lessons:Synthetic cannabinoids can trigger constrictive pericarditis,and clinicians should consider them when evaluating patients with compatible symptoms and exposure history.Further research on the cardiovascular effects of synthetic cannabinoids is needed and public education on potential harms is warranted.

Dispersive liquid-liquid microextraction,an effective tool for the determination of synthetic cannabinoids in oral fluid by liquid chromatography-tandem mass spectrometry

In the present work,dispersive liquid-liquid microextraction(DLLME)was used to extract six synthetic cannabinoids(JWH-018,JWH-019,JWH-073,JWH-200,or WIN 55,225,JWH-250,and AM-694)from oral fluids.A rapid baseline separation of the analytes was achieved on a bidentate octadecyl silica hydride phase(Cogent Bidentate C18;4.6 mm×250 mm,4μm)maintained at 37℃,by eluting in isocratic conditions(water:acetonitrile(25:75,V/V)).Detection was performed using positive electrospray ionization-tandem mass spectrometry.The parameters affecting DLLME(pH and ionic strength of the aqueous phase,type and volume of the extractant and dispersive solvent,vortex and centrifugation time)were optimized for maximizing yields.In particular,using 0.5 mL of oral fluid,acetonitrile(1 mL),was identified as the best option,both as a solvent to precipitate proteins and as a dispersing solvent in the DLLME procedure.To select an extraction solvent,a low transition temperature mixture(LTTM;composed of sesamol and chlorine chloride with a molar ratio of 1:3)and dichloromethane were compared;the latter(100μL)was proved to be a better extractant,with recoveries ranging from 73%to 101%by vortexing for 2 min.The method was validated according to the guidelines of Food and Drug Administration bioanalytical methods:intra-day and inter-day precisions ranged between 4%and 18%depending on the spike level and analyte;limits of detection spanned from 2 to 18 ng/mL;matrixmatched calibration curves were characterized by determination coefficients greater than 0.9914.Finally,the extraction procedure was compared with previous methods and with innovative techniques,presenting superior reliability,rapidity,simplicity,inexpensiveness,and efficiency.