Thoracic Aortic Dissection Associated with Marijuana Use

Mason, Erica K.; Gak, Anthony E.; Finno, Joan G.; Cannon, Robert D.; Jacoby, Jeanne L

doi:10.1016/j.jemermed.2019.03.034

Cited by 7 publications

(3 citation statements)

References 13 publications

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“…The THC patients were significantly younger than the non-THC patients (mean age of 48 versus 61 years, respectively, P=0.004). These results suggest that marijuana may be a contributing risk factor for acute type-A AD, although its pathophysiological mechanisms leading to dissection remain elusive [ 6 - 7 ]. Most likely, the AD in our current case resulted from the interplay of his chronic resistant hypertension secondary to Liddle’s syndrome, leading to atherosclerosis and aortopathy, combined with strong catecholamine triggers (masturbation after smoking marijuana), contributing to increased sheer stress to the aorta and creating the perfect scenario for the development and propagation of AD.…”

Section: Discussionmentioning

confidence: 99%

An Unexpected Cause of Chest Pain While Self-Pleasuring: A Ripping Doom Excitement

Escabí-Mendoza¹,

Diaz-Rodriguez²,

Gonzalez-Bravo³

et al. 2023

Cureus

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Acute aortic dissection (AD) involves the tearing of the aortic intima by shearing forces, resulting in a false lumen, which, depending on its location and extent, may lead to hemodynamic compromise, hypoperfusion of vital organs, or even rupture of the aorta. The classical presentation is a sudden chest or back pain described as sharp or ripping in quality. We present a 60-year-old male with a history of hypertension, Liddle’s syndrome, obstructive sleep apnea, and chronic cannabis use for insomnia who arrived at a non-PCI hospital complaining of severe retrosternal chest pain lasting several hours in evolution that started upon masturbation. The pain was ripping in character, starting retrosternally and radiating to his neck and back. After evidence of rising troponin values, he was initially diagnosed with non-ST segment elevation myocardial infarction (NSTEMI), managed with dual antiplatelet therapy with full anticoagulation, and subsequently transferred to our institution for further care. Shortly after his arrival at our hospital, he suddenly deteriorated with recurrent chest pain and hypotension, which triggered an emergent bedside echocardiogram evaluation. This revealed a hemodynamically significant pericardial effusion, moderate to severe aortic valve regurgitation (AR), and an intimal flap visualized on the ascending and descending aorta, suggestive of an extensive AD. A computerized tomographic angiogram confirmed the diagnosis of a Stanford type A AD that required an emergent surgical pericardiotomy, ascending aorta with partial arch replacement, and aortic valve repair. Often, AD may mimic an acute coronary syndrome (ACS) or even present with an acute myocardial infarction (AMI). The appropriate diagnostic imaging evaluation prior to the initiation of anticoagulation therapy should be done in patients with higher-risk clinical criteria for AD to reduce adverse treatment outcomes. The use of a simple three-step diagnostic algorithm for acute aortic syndromes (AAS) may decrease diagnostic delays, misdiagnosis, and inappropriate therapies.

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Section: Discussionmentioning

confidence: 99%

An Unexpected Cause of Chest Pain While Self-Pleasuring: A Ripping Doom Excitement

Escabí-Mendoza¹,

Diaz-Rodriguez²,

Gonzalez-Bravo³

et al. 2023

Cureus

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“…Several cases of cannabis-induced dissection have been reported in the literature, affecting coronary and cerebral arteries but also the aorta and renal arteries 13 , 14 .…”

Section: Discussionmentioning

confidence: 99%

Case Report: Spontaneous simultaneous coronary and carotid dissection in a young cannabis user

Amor¹,

Touil²,

Boukriba

et al. 2021

F1000Res

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Due to legalization of its consumption in some countries and its medical use as well as low toxic potential, cannabis remains the most widely used drug around the world and the rate of usage is only increasing. Nevertheless, there are several case reports of vascular complications following cannabis use even in young people without cardiovascular risk factors. We report the case of a cannabis smoker presenting to the emergency room for an ischemic stroke associated with an acute coronary syndrome related to a spontaneous simultaneous double dissection of the carotid artery and the left anterior descending artery, with a favourable outcome under medical treatment. This case shows the seriousness of complications due to the cannabis consumption, hence the need to limit or even prohibit its consumption.

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“…Of 51 dissection patients, 17.6% tested positive for THC, a positivity rate markedly higher than would be expected for the general population [SAMHSA 2019]. To the best of our knowledge, the potential association between marijuana use and aortic dissection has been examined by only 1 other group, who described a type A dissection in a 56-year-old man who smoked marijuana and had a family history of both aortic aneurysm and dissection [Mason 2019].…”

Section: E140mentioning

confidence: 99%

Marijuana: An Underappreciated Risk Factor for Acute Type A Aortic Dissection?

Sarmiento

Giammarino

Scheinerman

et al. 2021

HSF

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Background: Stimulants such as cocaine and amphetamines are well-established risk factors for acute aortic dissection. Despite the fact that marijuana is the most commonly used illicit drug in the United States, its relationship to acute aortic syndromes has not been well studied. Methods: A comprehensive retrospective review was undertaken of all consecutive patients who presented with acute Stanford type A aortic dissection from January 2017 to December 2019. Of 152 patients identified, 51 (33.6%) underwent comprehensive urine toxicology screening at clinical presentation. The characteristics and outcomes of the patients with urine results positive for tetrahydrocannabinol (THC) (n = 9, 17.6%) were compared with the 42 patients who had no evidence of recent marijuana consumption. Results: Of the 51 dissection patients who underwent broad-spectrum urine toxicology screening upon presentation, 9 (17.6%) returned positive results for THC, a proportion higher than would be expected for the general population. All THC patients were male; 3 concurrently tested positive for cocaine, and 3 others had evidence of recent amphetamine use. The THC patients were significantly younger than the non-THC patients (mean ± standard deviation age 48 ± 11.3 versus 61.4 ± 12.3 years, respectively, P = .004). A greater proportion of the THC cohort had a known diagnosis of aortic aneurysm before the dissection (44.4% versus 4.8%, P = .006). All patients underwent expeditious surgical repair. Thirty-day mortality for the entire cohort of 51 patients was 19.6% (10 deaths); for the THC group, it was 11.1% (1 death). There was no difference in the incidence of major postoperative complications between the 2 groups. Conclusion: Marijuana is the third most commonly used substance in the United States, after alcohol and tobacco. Although marijuana use is understudied, our results suggest that marijuana may be a contributing risk factor for acute type A aortic dissection, particularly in patients with other predisposing risk factors. Given the recent national trend to legalize marijuana, with the concomitant potential for exponential increases in its consumption, we suggest that the diagnosis of aortic dissection be considered earlier in any younger patient who presents with suggestive symptoms, especially if there is a history of recent marijuana use.

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Thoracic Aortic Dissection Associated with Marijuana Use

Cited by 7 publications

References 13 publications

An Unexpected Cause of Chest Pain While Self-Pleasuring: A Ripping Doom Excitement

An Unexpected Cause of Chest Pain While Self-Pleasuring: A Ripping Doom Excitement

Case Report: Spontaneous simultaneous coronary and carotid dissection in a young cannabis user

Marijuana: An Underappreciated Risk Factor for Acute Type A Aortic Dissection?

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