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Atypical Presentation of Cocaine-induced Type A Aortic Dissection: A Diagnosis Made by Transesophageal Echocardiography
  1. Kamran Riaz,
  2. Alan D. Forker,
  3. Mukesh Garg,
  4. Peter A. McCullough
  1. From the Department of Medicine, Section of Cardiology, University of Missouri- Kansas City, Kansas City, MO.
  1. Address correspondence to: Kamran Riaz, MD, MRCP, University of Missouri-Kansas City, Section of Cardiology, 2301 Holmes, Kansas City, MO 64108. E-mail kamranriaz{at}yahoo.com

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Cocaine abuse can cause a variety of cardiovascular emergencies, especially myocardial ischemia and infarction and is one of the leading causes of emergency room visits for chest pain evaluation in the young population.1In 1998, 1.7 million Americans were using cocaine at least once per month, with the highest rates of use among Americans age 18 to 25 years.2We present a unique case of cocaine abuse with multiple life-threatening cardiovascular effects.

A 43-year-old African American man presented to emergency room with shortness of breath of 4 hours' duration. He had chest pain earlier in the day, described as a mild pressure-like sensation localized in the substernal area, which gradually got better. Past medical history was significant for untreated hypertension. Family history was noncontributory. The patient admitted to tobacco, ethanol, and cocaine abuse for years, including cocaine within the last 12 hours.

On examination he was alert, oriented, and in minimal distress because of dyspnea. Vital signs were pulse, 130 beats/min; blood pressure, 120/70 mm Hg and equal in both arms and legs; afebrile; and respiratory rate, 20/min. No jugular venous distension noticed. Carotid upstroke was normal without audible bruits. Chest examination revealed basal crackles bilaterally. Examination of …

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