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(Circulation. 2002;105:1592.)
© 2002 American Heart Association, Inc.

Clinical Investigation and Reports

Acute Aortic Dissection Related to Crack Cocaine

Priscilla Y. Hsue, MD; Cynthia L. Salinas, MD; Ann F. Bolger, MD; Neal L. Benowitz, MD; David D. Waters, MD

From the Divisions of Cardiology, San Francisco General Hospital (P.Y.H, A.F.B., D.D.W.); the School of Medicine, University of California, San Francisco (C.S.); and the Divisions of Cardiology and Clinical Pharmacology, San Francisco General Hospital (N.L.B.), San Francisco, Calif.

Correspondence to David D. Waters, MD, San Francisco General Hospital, Room 5G1, Division of Cardiology, 1001 Potrero Ave, San Francisco, CA 94110. E-mail dwaters{at}medsfgh.ucsf.edu

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.

Methods and 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.

Key Words: aorta • cocaine • catecholamines

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