Dewar Krista, Nolan Seonaid
British Columbia Centre on Substance Use, Vancouver, British Columbia, Canada.
Department of Medicine, University of British Columbia, Vancouver, British Columbia, Canada.
BMJ Case Rep. 2017 Oct 27;2017:bcr-2016-218235. doi: 10.1136/bcr-2016-218235.
Cocaine is a widely used illicit substance and has previously been described as a risk factor for aortic dissection. We present a case of a young recreational cocaine user with uncontrolled hypertension who presented to hospital with acute chest pain and was diagnosed with an acute aortic dissection. The patient's last use of powdered cocaine was 3 days prior. A workup for secondary hypertension was negative and no other risk factors for aortic dissection were determined. In hospital, the patient was medically managed with multiple antihypertensive agents, was provided with education regarding the risk of ongoing stimulant use and resources to support his goal of abstinence. This case highlights the importance of considering a diagnosis of aortic dissection in a young patient presenting with acute chest pain, underscores the need for a thorough substance use history and provides a novel example of the potential danger of even recreational cocaine use.
可卡因是一种广泛使用的非法物质，此前已被描述为主动脉夹层的一个风险因素。我们报告一例年轻的娱乐性可卡因使用者，其患有未控制的高血压，因急性胸痛入院，被诊断为急性主动脉夹层。该患者最后一次使用粉末状可卡因是在3天前。继发性高血压的检查结果为阴性，未发现其他主动脉夹层的风险因素。在医院里，该患者接受了多种抗高血压药物的治疗，并接受了关于持续使用兴奋剂的风险的教育以及支持其戒酒目标的资源。这个病例强调了在出现急性胸痛的年轻患者中考虑主动脉夹层诊断的重要性，强调了全面了解药物使用史的必要性，并提供了一个新的例子，说明即使是娱乐性使用可卡因也存在潜在危险。
