Aortic dissection cocaine

Dissection of the aorta has been reported during cocaine use (82,83). The authors of these two reports noted that all six cases of this rare complication reported in the past 5 years were in men with pre-existing essential hypertension. In a review of emergency visits to a hospital during a 20-year period, 14 of 38 cases of acute aortic dissection involved cocaine use 6 were of type A and 8 of type B (84). Crack cocaine had been smoked in 13 cases and powder cocaine had been snorted in one case. The mean time of onset of chest pain was 12 hours after cocaine use. The chronicity of cocaine use was not known in most of the cases. The cocaine users were typically younger than the non-cocaine users. Chronic untreated hypertension and cigarette smoking were often present. 

Waters DD. Acute aortic dissection related to crack cocaine. Circulation 2002 105(13) 1592-5. 107. 

Riaz K, Forker AD, Garg M, McCullough PA. Atypical presentation of cocaine-induced type A aortic dissection a diagnosis made by transesophageal echocardiography. J 108. Investig Med 2002 50(2) 140-2. 

Palmiere C, Burkhardt S, Staub C, Hallenbarter M, Pizzolato GP, Dettmeyer R, La Harpe R. Thoracic aortic dissection associated with cocaine abuse. Forensic Sci Int 2004 141 137 12. 

Eagle KA, Isselbacher EM, DeSanctis RW International Registry for Aortic Dissection (IRAD) Investigators. Cocaine related aortic dissection in perspective. Circulation 2002 105 1529-30. 

Om A, Porter T, Mohanty PK. Transesophageal echocardio-graphic diagnosis of acute aortic dissection. Complication of cocaine abuse. Am Heart J 1992 123 532-4. 

A healthy 39-year-old man developed retrosternal chest pain radiating to the back with nausea and sweating. About 10-15 minutes before, he had inhaled cocaine for 2 hours and then smoked crack cocaine. He had an aortic dissection, which was repaired surgically. 

Cocaine can have marked effects on the heart and cardiovascular system. Adverse actions may include myocardial ischemia, cardiac arrhythmias, cardiotoxicity, hypertensive effects, cerebrovascular events, and a hyperco-agulable state (24,40). By 1997 more than 250 cases of myocardial infarction related to the recreational use of cocaine had been documented in the literature (41). Although less common, aortic dissection related to use of cocaine-free base ("crackcocaine") has also been documented (42). Seizures also can be associated with cocaine use (43). 

Painless aortic dissection has been attributed to cocaine use [24 ]. 

Daniel JC, Huynh TT, Zhou W, Kougias P, El Sayed HE, Huh J, Coselh JS, Lin PH. Acute aortic dissection associated with use of cocaine. J Vase Surg 2007 46 427-33. 

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