A 28-year-old man with an aortic dissection and history of cocaine abuse

Thoracic aortic dissection associated with cocaine abuse

Cardiovascular complications of cocaine abuse include myocardial ischemia and infarction, dysrhythmias, cardiomyopathies and aortic dissection. The case in point pertains to a 26-year-old, Caucasian male, substance abuser who suffered a thoracic aortic dissection following the use of crack cocaine. The autopsy and histological findings showed a connective tissue abnormality including a focal microcystic medial necrosis and a fragmentation of the elastic fibers in the arterial walls. Blood concentrations of cocaine and benzoylecgonine, taken individually, were considered to be within a potentially toxic range. Blood concentrations of methadone also indicated use of this drug at the same time. The small amounts of morphine found in the blood and urine were compatible with heroine or morphine use more than 24 h before death.

COCAINE USE AND ACUTE MYOCARDIAL INFARCTION

Cocaine use in the United States is widespread, affecting more than 30 million Americans. Although many of these persons do not seek healthcare, the overriding cause for hospitalization is cocaine-associated chest pain. Because only a minority of these patients suffer myocardial injury, it is important to exclude even rarer life-threatening causes for chest pain, such as aortic dissection or pneumothorax. Following that, a thorough knowledge of the pathophysiology and existing literature helps to provide cost-effective care, which focuses resources on those patients most likely to suffer complications. Regardless of the severity of complications, referral to cocaine detoxification programs, counseling, social support, and outpatient follow-up care for modification of cardiac risk factors is a fundamental component of long-term patient care.

Evaluation of patients with chest pain after cocaine use

Cocaine remains the most common cause of illicit drug-related visits to emergency departments, 40% of which result from chest pain. It is estimated that over half of the 64,000 patients evaluated annually for cocaine-associated chest pain will be admitted to hospitals for the evaluation of myocardial ischemia or infarction, at a health care cost of over eighty million dollars. Although the link between cocaine use and myocardial ischemia is well established, only about 6% of patients with cocaine-associated chest pain will demonstrate biochemical evidence of myocardial infarction. This article focuses on the evaluation of patients with chest pain following cocaine use, and concentrates on ways to improve diagnosis, management, and utilization of health care services.

Thoracic aortic dissection secondary to crack cocaine ingestion

Thoracic aortic dissection is a rare but recognized complication of crack cocaine inhalation. It is thought to be triggered in some cases by transient severe elevations in blood pressure, causing a shear effect on the thoracic aorta. Unrecognized, it can result in high morbidity and mortality. A case of an unusual presentation of thoracic aortic dissection following crack cocaine ingestion is reported.