Satoko Kanahara1, Mostafa El-Refai2, Nasser Lakkis1, Rashed Tabbaa1. 1. Department of Medicine and Section of Cardiology, Baylor College of Medicine, Houston, Texas, USA. 2. Department of Medicine and Section of Cardiology, Baylor College of Medicine, Houston, Texas, USA. Electronic address: elrefai@bcm.edu.
Abstract
Acute aortic dissection is rare among young patients in the absence of connective tissue disorders. One of the risk factors associated with aortic dissection among young patients is amphetamine use. We report a case of a 37-year-old female with a past medical history of hypertension presenting with syncope and altered mental status who was found to have an acute DeBakey Type I aortic dissection after ingestion of 3,4-methylenedioxymethamphetamine (MDMA), commonly known as ecstasy. This is the second case in the literature describing aortic dissection in relation to MDMA use. In both cases, the patients were young and had no history of connective tissue disorders or underlying valvular abnormalities. In this case, echocardiography was used to establish the diagnosis early. A transthoracic echocardiogram revealed a possible dissection flap prolapsing in through a normal aortic valve. Subsequently, a transesophageal echocardiogram revealed wide-open aortic regurgitation with several proximal dissection flaps from a normal caliber ascending aorta prolapsing into a normal tricuspid aortic valve. A high index of suspicion is necessary to diagnose and treat aortic dissection in young patients with a history of MDMA use. LEARNING OBJECTIVE: Recognize MDMA as a risk factor for acute aortic dissection, especially among younger patients with whom clinicians may not often associate aortic dissection.
Acute aortic dissection is rare among young patients in the absence of connective tissue disorders. One of the risk factors associated with aortic dissection among young patients is amphetamine use. We report a case of a 37-year-old female with a past medical history of hypertension presenting with syncope and altered mental status who was found to have an acute DeBakey Type I aortic dissection after ingestion of 3,4-methylenedioxymethamphetamine (MDMA), commonly known as ecstasy. This is the second case in the literature describing aortic dissection in relation to MDMA use. In both cases, the patients were young and had no history of connective tissue disorders or underlying valvular abnormalities. In this case, echocardiography was used to establish the diagnosis early. A transthoracic echocardiogram revealed a possible dissection flap prolapsing in through a normal aortic valve. Subsequently, a transesophageal echocardiogram revealed wide-open aortic regurgitation with several proximal dissection flaps from a normal caliber ascending aorta prolapsing into a normal tricuspid aortic valve. A high index of suspicion is necessary to diagnose and treat aortic dissection in young patients with a history of MDMA use. LEARNING OBJECTIVE: Recognize MDMA as a risk factor for acute aortic dissection, especially among younger patients with whom clinicians may not often associate aortic dissection.