Crack-Cocaine-Associated Aortic Dissection in Early Pregnancy

Abstract

Even though uncommon in pregnancy, aortic dissection is a potentially catastrophic vascular complication, occurring mainly in the late stages of pregnancy. Vascular events, including aortic dissection are recognized complications of crack-cocaine use. The authors report a case of aortic dissection in early pregnancy related to crack-cocaine use. They believe that the combined effects of pregnancy and crack cocaine on the vasculature create the requisite milieu potentiating such catastrophic events as aortic dissection. This paper reviews the possible underlying pathophysiologic mechanisms and the available diagnostic, therapeutic, and management options.

Cocaine-related acute aortic dissection: Patient demographics and clinical outcomes

“…Hsue et al noted that cocaine, particularly crack cocaine, had a definitive role in precipitating aortic dissection among a cohort of young, predominantly AfricanAmerican and hypertensive individuals. In their study, and in the previously reported case reports, the pattern of dissection (Stanford type A versus type B) was similar among cocaine users and non-cocaine users (15)(16)(17)(18)(19)(20).…”

“…The association of cocaine use with acute aortic dissection and the causal relationship of cocaine use with acute aortic dissection are not well defined (4,10,14). Several case reports of aortic dissection have been reported (15)(16)(17)(18)(19), but the article by Hsue et al (20) was the only study that clearly linked cocaine use and aortic dissection (20). Hsue et al noted that cocaine, particularly crack cocaine, had a definitive role in precipitating aortic dissection among a cohort of young, predominantly AfricanAmerican and hypertensive individuals.…”

Recreational Drug Use: A Major Risk Factor for Gastroschisis?

“…the rubella virus (Leek, 1972), (Warkany, 1971); chemical agents eg. methyl mercury (Harada, 1968); and a host of risk behaviours and environmental pollutants including smoking (Kistin et al 1996), recreational drugs (Lutiger et al 1991), (Bingol et al 1987), (Martinez-Frias, 1999), (Madu et al 1999), and pollutants from land fill sites (Dolk et al 1998) (Croen et al 1997). Nevertheless, despite these efforts, the cause of the majority of congenital anomalies remains unknown.…”

Cocaine and aortic dissection

“…20 As in patients without cocaine exposure, the pain of cocainerelated aortic dissection pain is described as stabbing, tearing or ripping. [32][33][34][35][36][37][38][39][40][41][42][43][44][45][46] Rashid and colleagues noted that nine of 12 patients with aortic dissection associated with cocaine use had chest pain or back pain at presentation. 32 Pain has also been described in the neck, jaw, lumber region, flank, abdomen and extremities depending on the location and extent of dissection.…”

“…32 Pain has also been described in the neck, jaw, lumber region, flank, abdomen and extremities depending on the location and extent of dissection. [1][2][3][4][5][32][33][34][35][36][37][38][39][40][41][42][43][44][45][46] Ischemic cardiac chest pain may occur with retrograde dissection into the right coronary artery producing myocardial infarction or with co-existent myocardial infarction from cocaine-induced vasospasm. 33,43 In patients with cocaine-related aortic dissection, hypertension occurs at presentation in 75-80% of cases compared with approximately 50% of cases unrelated to cocaine use.…”