Abstract
Background
Acute aortic dissection (AD) is a life-threatening condition most frequently seen
in men with an average age >60 years. Risk factors include family history, hypertension
and cigarette smoking. AD has been associated with methamephatamine and cocaine use
but has not previously been associated with the use of marijuana.
Case Report
We report a case of an aortic dissection in a 56-year-old male that occurred while
smoking marijuana. The patient had a family history significant for both aortic aneurysm
and dissection. He developed crushing chest pain, shortness of breath, and diaphoresis
shortly after smoking marijuana from a glass pipe called a “bubbler”. His ECG was
unremarkable as was his chest x-ray and initial labs. CT scan revealed an Aortic dissection
from the aortic root to the internal iliac artery.
Why Should an Emergency Physician Be Aware of This?
The role of cannabis in cardiovascular disorders is complex and not completely understood.
Acute chest pain associated with marijuana use typically raises concern for pneumothorax
or pneumomediastinum. Marijuana has also been associated with hypertension and arrhythmias
and has also been associated with an increased risk of myocardial infarction. However
a link between marijuana and acute aortic dissection has not been previously reported.
As more states legalize medical and recreational marijuana use this is a timely and
important consideration for Emergency physicians evaluating chest pain. Our goal is
to document the temporal relationship of cannabis use and acute aortic dissection
in a recent ED patient.
Keywords
To read this article in full you will need to make a payment
Purchase one-time access:
Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online accessOne-time access price info
- For academic or personal research use, select 'Academic and Personal'
- For corporate R&D use, select 'Corporate R&D Professionals'
Subscribe:
Subscribe to Journal of Emergency MedicineAlready a print subscriber? Claim online access
Already an online subscriber? Sign in
Register: Create an account
Institutional Access: Sign in to ScienceDirect
References
- Management of acute aortic syndrome.Nat Rev Cardiol. 2014; 12: 103-114
- Clinical profiles and outcomes of acute type B aortic dissection in the current era: lessons from the International Registry of Aortic Dissection (IRAD).Circulation. 2003; 108: II312-II317
- A case based approach to clinical genetics of thoracic aortic aneurysm/dissection.Biomed Res Int. 2016; 2016: 9579654
- Familial non-syndromal thoracic aortic aneurysms and dissections - Incidence and family screening outcomes.Int J Cardiol. 2016; 220: 43-51
- Acute aortic dissection: perspectives from the International Registry of Acute Aortic Dissection (IRAD).Eur J Vasc Endovasc Surg. 2009; 37: 149-159
- Acute aortic dissection: pathogenesis, risk factors and diagnosis.Swiss Med Wkly. 2017; 147: w14489
- Methamphetamine as a risk factor for acute aortic dissection.J Forensic Sci. 1999; 44: 23-26
- Smoking and vascular risk: are all forms of smoking harmful to all types of vascular disease?.Public Health. 2013; 127: 435-441
- The large spectrum of pulmonary complications following illicit drug use: features and mechanisms.Chem Biol Interact. 2013; 206: 444-451
- Cocaine and coronary artery diseases.J Cardiovasc Med. 2017; 18: 291-294
- How medical marijuana smoothed the transition to marijuana legalization in the United States.Annu Rev Law Soc Sci. 2017; 13: 181-202
- Marijuana’s dose-dependent effects in daily marijuana smokers.Exp Clin Psychopharmacol. 2013; 21: 287-293
- Effect of abruptly increased intrathoracic pressure on coronary blood flow velocity in patients.Am Heart J. 1990; 119: 863-870
- Acute aortic dissection provoked by sneeze: a case report.Emerg Med J. 2005; 22: 756-757
- Role of cannabis in cardiovascular disorders.J Thorac Dis. 2017; 9: 2079-2092
Article info
Publication history
Published online: May 21, 2019
Accepted:
March 27,
2019
Received in revised form:
March 17,
2019
Received:
April 25,
2018
Identification
Copyright
© 2019 Published by Elsevier Inc.
