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A 15-year-old teenager presented with complaint of chest pain for 3 h. He had been a heavy bonzai smoker for 2.5 years, and approximately 2 h passed after this last smoke. His blood pressure and heart rate were 84/47 mm Hg and 104 bpm, respectively. Electrocardiography (ECG) revealed right bundle-branch block and ST-segment elevation in leads DI, II, III, aVL, aVF, and V4-6 (Fig. 1a). Transthoracic echocardiography (TTE) revealed moderate mitral regurgitation, +2 spontaneous echo contrast (SEC) in left chambers, and left ventricular (LV) inferior and posterolateral wall hypokinesia with an ejection fraction (EF) of 40% (Video 1–3). Aspirin, 300 mg and clopidogrel, 600 mg were administered with the diagnosis of ST-elevation myocardial infarction, and the patient was referred to the catheterization laboratory. Coronary angiography (CAG ) revealed normal coronary arteries (Fig. 2a–d). Troponin I levels were 6.4 ng/mL (0–0.028 ng/mL), and the other biochemical findings were unremarkable. Considering coronary vasospasm, we initiated diltiazem therapy. After 2 h of initiation, the patient complained of right-sided blurred vision. Initial cranial multidetector computed tomography findings (MDCT) were normal (Fig. 3a). A control MDCT showed acute occipital lobe infarction (Fig. 3b). Because of +2 SEC in the left chambers, we presumed cardio-embolism to be the main reason for the stroke. After 7 days of low-molecular-weight heparin and warfarin therapy, the patient’s visual impairment was alleviated. He was discharged on the 10th day and called for a control visit after 1 month. At the control visit, ECG revealed inverted T waves in leads DI, II, aVL, and V4-6 (Fig. 1b). TTE revealed mild mitral regurgitation and normal LV wall motion (Video 3, 4). Cardiac magnetic resonance imaging (MRI) was performed for confirmation, and it revealed late myocardial gadolinium enhancement in the posterolateral portion of the heart (Fig. 4a, b; Video 5). Discussion

Acute myocardial infarction and ischemic stroke coexistence due to marijuana abuse in an adolescent