05 Mar Cocaine Use and Aortic Dissection
Aortic dissection is an extremely serious, frequently fatal health emergency that occurs when a rupture or tear forms in the inner surface of the aorta, the main artery that sends blood from the heart to the rest of the body. Doctors sometimes also refer to the condition as a dissecting aneurysm. Although aortic dissection is fairly rare in all population groups, people who use cocaine can significantly increase their risks for developing the condition. Crack cocaine users, in particular, bear the brunt of these elevated risks.
Aortic Dissection Basics
Arteries are the blood vessels that carry oxygen-rich blood from the heart and transport it to various tissues and organs throughout the body. The aorta, which connects directly to the heart at the lower chamber called the left ventricle, acts as the main conduit that feeds blood to all other arteries. In line with this role, it is the body’s single largest artery. The force of blood pumping from the left ventricle puts tremendous pressure on the upper end of the aorta. The artery combats this pressure with the help of a triple-layered wall that stretches and adjusts in response to the repeated changes in blood flow associated with normal beating of the heart.
Aortic dissection occurs when one or more of the layers in the aortic wall ruptures and lets blood flow abnormally within the wall’s structure. Dangerous, but relatively mild problems will appear if a dissection involves just the innermost layer of the aortic wall, or both the innermost layer and the middle layer of the wall. Deadly problems can develop rapidly if a dissection goes all the way through these two layers and also penetrates the artery’s outermost layer. Specific complications associated with the presence of an aortic dissection include damage to the valve between the aorta and the left ventricle, kidney failure, stroke, paralysis, fatal damage to the body’s intestinal function, and fatal bleeding into the pericardium, a sac that surrounds and usually protects the heart.
When cocaine enters the body, it triggers an unusual increase in norepinephrine, a chemical that’s used to regulate nerve cell function in an involuntary network called the sympathetic nervous system. As norepinephrine levels rise, activity in this system increases. Normally, this type of heightened sympathetic nerve activation only occurs when any given person is exposed to physical danger or unusual amounts of mental or physical stress.
Cocaine produces this activation artificially and generates related changes in the body’s cardiovascular (heart and blood vessel) function that include a rapid heartbeat, unusual constriction (narrowing) of the blood vessels, and an increase in blood pressure that stems directly from unusual blood vessel constriction. The blood pressure changes associated with cocaine use are not steady or gradual; instead, they occur in surges that can drastically boost pressure levels for limited amounts of time.
In addition to the cardiovascular changes brought about by an increase in norepinephrine levels, cocaine in the bloodstream directly irritates the tissues that form the layers of the aortic wall, according to the authors of a study published in 2010 in the journal Vascular Medicine. This irritation can predispose any given cocaine user to an aortic dissection by weakening the wall of the aorta and gradually reducing its normal stretchiness over time. While the physical actions of cocaine on the aorta’s wall set up the conditions for an aortic dissection, it is typically the repeated surge of blood pressure associated with cocaine use that actually triggers the onset of dissection. Cocaine use can also contribute to the likelihood of aortic dissection by promoting premature development of the artery-hardening condition known as arteriosclerosis or atherosclerosis.
Crack cocaine users are particularly susceptible to the development of an aortic dissection, according to a study published in 2002 in the American Heart Association journal Circulation. Although no one knows for sure, this increased risk apparently stems from the effects of crack’s rapid entry into the bloodstream through the lungs. Cocaine users who smoke tobacco can also increase their aortic dissection risks by speeding up the process of arteriosclerosis in the wall of the aorta. Thirty-three percent of all people with an undetected or untreated case of aortic dissection die within 24 hours after the initial tear in the aortic wall develops. Fifty percent die within two days, while fully 75 percent die within two weeks.
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