Aortic Dissection After Ingestion of "Ecstasy" (MDMA)

A 29-year-old man died from aortic dissection and cardiac tamponade after taking ecstasy (MDMA) at a rave. He had no history of hypertension or other known risk factors for aortic dissection, though a minor degree of cystic medial necrosis was found in the aorta. Autopsy toxicology showed low residual MDMA levels in the blood about 48 hours after ingestion. The report suggests a probable link between MDMA use and aortic dissection in a previously healthy young adult, discusses possible mechanisms, and notes challenges in diagnosing this complication.

Study at a glance

Abstract

The authors report a case of aortic dissection and cardiac tamponade in a 29-year-old man after ingestion of ecstasy (methylenedioxymethamphetamine, MDMA) at a "rave" party. There was no history of hypertension, myxoid heart disease, or other risk factors for aortic dissection in the deceased, although a minor degree of cystic medial necrosis was noted on histologic examination of the aorta. Autopsy toxicology revealed low residual levels of MDMA in the blood about 48 hours after ingestion of the drug. This case report describes a probable association between MDMA ingestion and aortic dissection in a previously well young adult. The likely mechanisms are discussed, and the difficulties in diagnosing this complication are highlighted.