Spontaneous coronary artery dissection associated with cocaine use: A case report and brief review
Introduction
Spontaneous, nontraumatic dissection of the coronary arteries is a rare occurrence first described by Pretty in 1931 [1]. In a 1999 review, Elming and Kober [2] identified 142 cases of spontaneous coronary artery dissection, only 39 of which occurred in men. Including our own case, we identified nine additional incidences of spontaneous coronary dissection in men [2], [3], [4], [5], [6], [7], [8], [9], [10], [11], [12] for a total of 48. Only one reported case of isolated coronary artery dissection has been associated with cocaine use [9]. That patient survived following bypass surgery. Presented below is what we believe to be the first fatal case of cocaine-associated coronary artery dissection and the first case of cocaine-associated left anterior descending artery dissection.
Section snippets
Case report
A 23-year-old male with a history of intravenous drug abuse and hepatitis C was found unconscious on the ground near a motorcycle. There were no external signs of trauma and no witnesses. He was transported to an outlying medical center where he was hypoxic and hypotensive, requiring pressors and mechanical ventilation. A urine drug screen was positive for cocaine metabolites, benzodiazepines, and opiates. Because of concern for intracranial hemorrhage, he was transferred to the University of
Discussion
Coronary artery dissection is a well-documented, traumatic complication of coronary catheterization up to 0.3% of the time [13] and is also a known sequela of blunt chest trauma [14], [15]. The pathophysiology of spontaneous coronary dissection, however, remains unclear, and the mechanism probably varies between subsets of patients. About three-quarters of all reported cases of spontaneous coronary dissection have occurred in women, and nearly one third of those were pregnant or peripartum [2].
Conclusion
The realization that cocaine use can be associated with dissection of the coronary arteries is important. In the case presented, the extent of myocardial damage at the time of presentation was already extensive, and more intensive therapy would not likely have changed the outcome. In practice, however, it is reasonable to assume that acute coronary dissection can present early, at a stage at when therapeutic intervention can be beneficial and life saving. Dissection of the coronary arteries has
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