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Drug points: Acute dissection of the aorta with amphetamine misuse

BMJ 1997; 314 doi: https://doi.org/10.1136/bmj.314.7095.1665 (Published 07 June 1997) Cite this as: BMJ 1997;314:1665
  1. W C Dihmisa,
  2. P Ridleya,
  3. J P Dhasmanaa,
  4. J D Wishearta
  1. a Department of Cardiac Surgery, Bristol Royal Infirmary, Bristol BS2 8HW

    A 27 year old man who was an intravenous amphetamine misuser presented with a cold ischaemic left leg and chest pain after cutting wood. Dissection of the entire aorta was seen on computed tomography. He was transferred to this hospital, where transthoracic echocardiography confirmed the diagnosis. Surgery showed an intimal tear in the ascending aorta. The segment of aorta containing the intimal tear was excised, the aortic wall reconstituted, and continuity restored with an interposition graft. He died 32 days later as a result of septicaemia and multiorgan failure. Analysis of the blood samples taken at presentation showed a plasma amphetamine concentration of 0.14 mg/l.

    Acute dissection of the aorta is rare in young adults.1 2 The use of amphetamine enhances noradrenaline release, causing surges in blood pressure. Misuse of cocaine, which has a similar action, has been implicated in the pathogenesis of aortic dissection.3 4 To our knowledge, there have been no reports associating acute dissection of the aorta with amphetamine use. Our patient was chopping wood, a strenuous exercise with an isometric component, which may have contributed to a surge in blood pressure. Serum amphetamine concentrations of 0.5 mg/l or less are not usually associated with serious toxicity, although the half life for amphetamine is short and thus the measured plasma concentration of 0.14 mg/l indicates that amphetamine was present and that the concentration had been higher.

    The amphetamines taken by this patient may have been contaminated with other drugs with an additive effect.

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