A case of radial arteriovenous fistula during coronary angiography.

activation of cannabinoid receptors, which are present in brain, heart, blood vessels, spleen and immune system (1,2). Cannabis increases sympathetic activity while decreasing parasympathetic activity, producing tachycardia and increased myocardial contractility (4-6). Additionally, smoked cannabis is associated with an increase in carboxyhemoglobin, resulting in decreased oxygen-carrying capacity (4-6). Therefore, cannabis associated ACS may result from increased oxygen demand not met by a myocardial supply of oxygen (4-6). These adverse hemodynamic changes due to cannabis smoking may lead to plaque rupture in vulnerable individuals culminating in the ACS and sudden death (4-6). The ACS has also been reported in the presence of normal coronary arteries suggesting coronary vasospasm (4-6). Sildenafil citrate alone can cause mean peak reductions in systolic/diastolic blood pressure that are not dose related, whereas the heart rate is unchanged (3). Therefore, these adverse hemodynamic changes, particularly in association with aggravating factors such as decreased blood pressure due to sildenafil citrate may explain the occurrence of symptoms and myocardial ischemia in myocardial bridge.