cureus.com – We present a 60-year-old male with a history of hypertension, Liddle’s syndrome [an inherited form of high blood pressure], obstructive sleep apnea, and chronic cannabis use for insomnia who arrived at a non-PCI hospital complaining of severe retrosternal chest pain lasting several hours in evolution that started upon masturbation.
[A non-PCI (Percutaneous Coronary Intervention) hospital is a facility that is not equipped and staffed to perform angioplasty and stenting, minimally invasive procedures to open blocked coronary arteries, improving blood flow to the heart and relieving symptoms like chest pain. Retrosternal chest pain is pain occurring behind the sternum]
The pain was ripping in character, starting retrosternally and radiating to his neck and back.
After evidence of rising troponin values [an indicator of damage to the heart muscle], he was initially diagnosed with non-ST segment elevation myocardial infarction [partial blockage of one of the coronary arteries, causing reduced flow of oxygen-rich blood to the heart muscle], managed with dual antiplatelet therapy with full anticoagulation, and subsequently transferred to our institution for further care.
SHOULD YOU BE WORRIED?
“Aortic dissection is a lethal condition. Coitus or masturbatory activity is one of the rarest risk factors for aortic dissection.” – Journal of Cardiovascular Disordorders, 2015;2(2): 1012.
Shortly after his arrival at our hospital, he suddenly deteriorated with recurrent chest pain and hypotension, which triggered an emergent bedside echocardiogram evaluation.
This revealed a hemodynamically significant pericardial effusion, moderate to severe aortic valve regurgitation (AR), and an intimal flap visualized on the ascending and descending aorta, suggestive of an extensive AD.
A computerized tomographic angiogram confirmed the diagnosis of a Stanford type A AD that required an emergent surgical pericardiotomy, ascending aorta with partial arch replacement, and aortic valve repair.
Often, AD may mimic an acute coronary syndrome (ACS) or even present with an acute myocardial infarction (AMI).
The appropriate diagnostic imaging evaluation prior to the initiation of anticoagulation therapy should be done in patients with higher-risk clinical criteria for AD to reduce adverse treatment outcomes.
The use of a simple three-step diagnostic algorithm for acute aortic syndromes (AAS) may decrease diagnostic delays, misdiagnosis, and inappropriate therapies.
Copyright © 2023, Escabi-Mendoza et al. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited. An Unexpected Cause of Chest Pain While Self-Pleasuring: A Ripping Doom Excitement; Jose Escabi-Mendoza 1, Porfirio E Diaz-Rodriguez 1,✉, Diego H Gonzalez-Bravo 1, Eduardo Partida-Rodriguez 1; Editors: Alexander Muacevic, John R Adler. Published: May 02, 2023. DOI: 10.7759/cureus.38436
