Background
The elevated risk of triggering a myocardial infarction by smoking cannabis is limited to the first 2 h after smoking.

Aim
To examine the possible role of cannabis in cardiac deaths.

Cases and results From 3,193 coroners’ cases over 2 years, there were 13 cases where the clinical information was compatible with a primary cardiac cause of death. An inquest was held in three cases. Myocardial infarction was the primary cause of death in 54%. Other causes were sudden adult death syndrome, sudden death in epilepsy, and poisoning by alcohol and diazepam. Cannabis was mentioned once only on a death certificate, but not as a cause of death. Blood delta9 tetrahydrocannabinolcarboxylic acid was recorded in one case and in no case was plasma tetrahydrocannabinol (THC) measured.

Conclusions
To attribute sudden cardiac death to cannabis, plasma THC should be measured in the toxicology screen in coroners’ cases where urine cannabinoids are positive. A positive urine cannabinoids immunoassay alone is insufficient evidence in the linkage of acute cardiac death and cannabis.