Acute aortic dissection related to crack cocaine.
BACKGROUND
Although single case reports have described acute aortic dissection in relation to cocaine use, this condition is not widely recognized, and the features of cocaine-related aortic dissection have not been defined.


RESULTS
We reviewed all available hospital charts from 1981 to 2001 with the ICD-9 diagnosis of aortic dissection. Among the 38 cases of acute aortic dissection, 14 (37%) were related to cocaine use. Crack cocaine was smoked in 13 cases and powder cocaine was snorted in 1 case. The mean interval between cocaine use and the onset of symptoms was 12 hours (range, 0 to 24). Patients with cocaine-related dissection were much younger and more likely to undergo surgery compared with patients with aortic dissection without cocaine use. Most in the cocaine group were black, with a history of untreated hypertension. However, the two groups did not differ in other respects, including dissection type.


CONCLUSIONS
In an inner city population, acute aortic dissection in the setting of crack cocaine use is common, presumably as a consequence of abrupt, transient, severe hypertension and catecholamine release. This diagnosis should be considered in cocaine users with severe chest pain.
Hsue
Priscilla Y
PY
Division of Cardiology, San Francisco General Hospital, CA 94110, USA.
Salinas
Cynthia L
CL
Bolger
Ann F
AF
Benowitz
Neal L
NL
Waters
David D
DD
D000208:Acute Disease; D000328:Adult; D001018:Aortic Diseases / Q000175:diagnosis / Q000208:ethnology / Q000209:etiology*; D044383:Black People; D016578:Crack Cocaine / Q000009:adverse effects* / Q000494:pharmacology; D005260:Female; D006801:Humans; D006973:Hypertension / Q000150:complications; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D012307:Risk Factors; D014504:Urban Health
D016578:Crack Cocaine