Talk About a Bad Trip!: Psilocybin Use With Pre-Existing Cardiovascular Disease, a Case Report

Document Type

Conference Proceeding

Publication Date

4-7-2026

Publication Title

Journal of the American College of Cardiology

Abstract

BACKGROUND Psilocybin, a serotonergic psychedelic, is gaining popularity for recreational and therapeutic use. While generally well tolerated, its ability to induce catecholamine surges may aggravate underlying cardiovascular conditions, thereby increasing the risk of acute myocardial ischemia and arrhythmias. Currently, psilocybin use is only studied to be cardiovascularly safe in patients without preexisting cardiac risk factors. CASE We report a 64-year-old male with CAD, HTN, and HLD who presented to the hospital with ventricular fibrillation (VF) cardiac arrest. Blood pressure on admission was 214/124 mmHg, and the initial ECG revealed anterolateral STEMI. Social history indicated ingestion of a psilocybin-containing chocolate bar before admission. The patient underwent emergent percutaneous coronary intervention with DES x2 of the proximal first obtuse marginal artery, thought to be the culprit lesion. DECISION-MAKING Psilocybin pharmacokinetics demonstrate catecholamine surges within hours of ingestion, resulting in increased BP and HR. It is hypothesized that psilocybin Psilocybin triggered a catecholamine surge, exacerbating the patient’s underlying cardiovascular risk factors leading to a hypertensive crisis that may increase risk for plaque rupture and myocardial infarction. This case highlights the importance of considering recent psychedelic use as a trigger in patients with established cardiovascular disease presenting with acute coronary syndromes or arrhythmias. CONCLUSION It is known that psilocybin-induced catecholamine release can cause hypertensive crises. However, retrospective studies and case reports, such as this one, are beneficial to expanding the literature on psilocybin use and its effects on the cardiovascular system, as it is possible that it could precipitate life-threatening myocardial infarction in patients with pre-existing cardiovascular disease.

Volume

87

Issue

13 Suppl

First Page

A1313

Comments

American College of Cardiology 75th Annual Scientific Session & Expo, March 28-30, 2026, New Orleans, LA

Last Page

A1313

DOI

10.1016/j.jacc.2026.02.3249

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