Coronary Heart Disease is the leading cause of cardiovascular-related mortality in the US with a reported incidence of MI occurring every 40 s.1 In 2022, cardiovascular diseases were the leading cause of mortality in the US, with a reported 699,659 deaths.2 The association between marijuana use and myocardial infarction has been reported in current literature among young, healthy individuals with no underlying comorbidities or risk factors.3 The United Nations Office on Drugs and Crime (UNODC) estimated the yearly marijuana use in 2020 to be 209 million people, accounting for 4 % of the global population. Prevalence rose by 8 percent compared to 2010, with adolescents aged between 15 and 16 years comprising 5.8 %.4 The occurrence of MI increases five-fold within the first hour of marijuana use.5 It is popular among youth, with consumption occurring at lower ages when compared to other illicit drugs such as cocaine and opiates.6 The suggested mechanisms of marijuana use and its effects on the heart include stimulation of the autonomic nervous system, platelet dysfunction, direct smoke inhalation effects, and vasospastic effects of the coronary vessels. The proposed pathophysiology is via the upregulation of carbonyl reductase 1 (CBR1) receptors by Delta-9-tetrahydrocannabinol (THC) located in cardiac myocytes and coronary vasculature. This causes pro-inflammatory effects, inducing the production of reactive oxygen species (ROS).3 We discuss a 19-year-old male with no past medical history who presented to the emergency department (ED) after a cardiac arrest and was found to have a STEMI secondary to marijuana use. In addition, through this case report, we review current literature discussing the association between acute coronary syndromes and marijuana use.