Many Los Angeles adults incorporate cannabis into their daily routines. Dispensaries abound in Westwood and Brentwood, Beverly Hills, Santa Monica, and West Hollywood. Edibles, tinctures, and pre-rolls are abundant in LA homes, typically stored in nightstands next to cardiac prescription medication. Cannabis consumption is no longer predominantly in the young adult population. The fastest growing demographic is the 50-plus population who use cannabis to help relieve pain and anxiety and to aid sleep.

Westwood cardiac surgeon Dr. Maria Tehrani sees patients at Ronald Reagan UCLA Medical Center who have more questions about cannabis than ever before. Her patients are not looking for her to be the cannabis police. Instead, they want to know what the research says about the effect cannabis has on the heart, who is at risk, and what she needs to know before their surgery.

THC targets your blood and heart in the first few minutes of consumption. With edibles, it can take an hour or more. When that happens:

– Your heart rate can increase 20 to 50 beats per minute

– Your blood pressure can increase, decrease and cause dizziness

– Your blood vessels can constrict

– Your heart muscle can demand more oxygen

– Your risk for blood clots can increase

– You can experience an irregular heart beat and AFib

– Your blood pressure can decrease and cause you to faint

For most healthy young people, these effects go away in a short amount of time. However, if you have coronary artery disease, AFib, and especially if you’ve had heart failure or a heart attack recently, these effects can trigger pain in your chest, complications with your heart’s rhythm, and in very extreme cases heart attacks.

Cannabis edibles cause different effects. When THC is smoked or vaped, the effects are very different to when it is eaten. The liver processes ingested THC different than the lungs. As a result, the effects come on in 60 to 120 minutes, and can last 6 to 12 hours. The effects can also be very unpredictable and are much more intense.

Patients living in Los Angeles illustrate the problem and put the hospital staff in situations most familiar. For example, a patient eats a gummy, feels nothing, and takes a second gummy after 45 minutes. When both hit, the patient’s heart rate spikes, anxiety surges, blood pressure begins swinging, and the patient ends up in the emergency room, convinced the patient is experiencing a heart attack.

New and returning patients who use cannabis after a long hiatus experience the same episodes that most emergency rooms across Los Angeles are familiar with. All the episodes resolve at the emergency room, but the risk is high for patients with heart disease because THC can strain a patients heart at a prolonged peak.

Cannabis that patients smoke and its effect on the heart. Smoking, through joints, pipes, or bongs, THC especially along with smoke combustion, leaves byproducts similar to cigarette smoke. Chronic bronchitis, reduced lung function, and irritation of the blood vessels become evident in regular smokers. Lung and heart health are joined at the hip, and what damages one usually affects the other.

These users are seeing similar symptoms correlate with their usage patterns:

– Some report earlier symptoms of heart disease

– More report developing AFib

– There are increased reports of heart attacks among younger users, with attacks occurring within the hour after use

– Long term heavy users of cannabis see cannabis-related cardiomyopathy

Older Adults and Cannabis

One of the major trends in LA’s cannabis market has been the increased use of individuals over 50. Many of these individuals use cannabis to help with sleep and anxiety, to deal with pain, and as a substitute for opioids. This population has the highest prevalence of cardiovascular disease.

Older patients are at a higher risk of:

– Changes in bleeding risk caused by cannabis and blood thinners. This is particularly important because of how warfarin and some of the more modern blood thinners are processed by the liver.

– Changes in bleeding risk and medication levels caused by some heart rate AFib medications.

– Changes in blood pressure and cardiomyopathy due to the use of cannabis.

– Postural Hypotension, which significantly increases the risk of falls.

– Changes in your ability to get quality sleep.

Any form of cannabis use should be communicated to your cardiologist and your pharmacist especially if you are on heart medications. Many of these drug interactions are dangerous if not reported.

It’s great that cannabis is more recognized for medicinal purposes and is more widely available, but it also means that many people may be using cannabis products without even knowing what’s in them, which leads to a complicated and complicated history of products and ingredients they may even consider for post-op pain relief. Opioids and surgical cannabis interact in other ways too, which is a big potential problem. Because of cannabis’s ability to withdraw and the toll the withdrawal may have on post-op recovery, the body seems to go into a shock-like state if used too often within the month or few weeks leading to the surgery.

It’s best to stop or entirely cut cannabis use around a month before a cardiac procedure. Only your surgical team can give you the best advice on your particular usage and the correct timing to stop.

Once patients start recovering, it is okay for them to start using less harmful forms of cannabis, including alcoholic, edible, and pill forms. The best way to ensure a fast recovery is to heavily avoid any smoking or vaping. This also ensures a safe recovery.

What about CBD?

Pure CBD products do not have THC and thus do not have the same profiles for cardiovascular stimulation as pure THC products. Pure CBD products do not significantly raise your heart rate or blood pressure. It’s still important to remember that:

– CBD interacts with cardiac medications because of how it affects liver enzymes.
– The quality of CBD products is extremely inconsistent and the amount of actual CBD is unpredictable.
– Many products marketed as CBD that are sold outside of licensed dispensaries actually contain THC and other cannabinoids.

Mention to your physician that you are using CBD products for sleep, pain, or anxiety, especially if you are taking any kind of blood thinner or cardiac rhythm medication.

When to See a Cardiac Specialist

You should see a cardiologist or cardiac surgeon if you have any of the following:

– Cardiac symptoms that you think are related to the use of cannabis.

– Plans for any kind of cardiac surgery and use cannabis in any form on a regular basis.

– A cardiac diagnosis and the use of edible, smoked, or vape cannabis products.

– Concerns about cardiac medications and the use of cannabis.

– An emergency room visit related to the use of a cannabis edible that you wish to have more information about.

If you have any of the following symptoms, you need immediate emergency medical care. Call 911.

– Severe and sudden chest pain.

– Fainting.

– Signs of a stroke, including facial drooping, weakness or loss of strength, especially on one side of the body, or speech that is hard to understand or is slurred.

Cannabis has been made legal in California and for the most part can be used safely by healthy adults. That being said, if you have heart disease, cardiac risk factors, or if you are having surgery, using cannabis should be discussed. Dr. Maria Tehrani has a focus on cardiac health, and if you are a cannabis user, you can expect a thorough and honest cardiac evaluation. All of our conversations are focused on your health and are completely private.