A Rare Presentation of a Life- Threatening Condition Secondary to Masturbatory Activity: A Case Report

Case Report

J Cardiovasc Disord. 2015;2(2): 1012.

A Rare Presentation of a Life- Threatening Condition Secondary to Masturbatory Activity: A Case Report

Ali Ridha¹*, Shoaib Safiullah², Sarah Al- Abayechi³, Ahmed Ghadai4 and Amin Ur Rehman Nadeem5

¹Chicago Medical School/Rosalind Franklin University of Medicine and Science, USA

²Chicago Medical School/Rosalind Franklin University of Medicine and Science, USA

³College of Medicine/Baghdad University, Iraq

4Chicago Medical School/Rosalind Franklin University of Medicine and Science, USA

5Chicago Medical School/Rosalind Franklin University of Medicine and Science, USA

*Corresponding author: Ali Ridha, Chicago Medical School/Rosalind Franklin University of Medicine and Science, 3333 Green Bay Rd, North Chicago, IL 60064 USA

Received: April 29, 2015; Accepted: May 07, 2015; Published: May 08, 2015

Abstract

Aortic dissection is a lethal condition. Coitus or masturbatory activity is one of the rarest risk factors for aortic dissection. The most frequent predisposing factors are chronic systemic hypertension, hereditary connective tissue diseases, and congenital aortic valve diseases. To our knowledge, this is the first reported case of aortic dissection after masturbatory activity. We report the case of a 67 year old man who developed sudden onset chest pain during masturbatory activity. This presentation was atypical in that his pain radiated to his upper abdomen and lower back with relatively equal blood pressure in both arms. Computed tomography angiography showed a type an aortic dissection that extended from the ascending aorta to the level of the origin of superior mesenteric artery. Patient was transferred to the operating room immediately with subsequent successful treatment. This case illustrates that aortic dissection may be added to the complications seen after acute onset of peri- or postmasturbatory activity severe chest pain.

Keywords: Aortic Dissection; Debakey Classification; Stanford Classification; Computed Tomography Angiography

Case Presentation

A 67 year-old Caucasian man presented on December 13, 2014 to the emergency department in North Chicago, Illinois with acute onset of chest pain that started on the morning of arrival while engaging in masturbatory activity. The pain was sharp, constant, 10/10 in severity, and located midsternal with radiation towards the upper abdomen and lower back. It was associated with nausea, diaphoresis and dyspnea. His past medical history was significant for hypertension controlled by diet and exercise, chronic obstructive pulmonary disease, and compensated alcoholic cirrhosis.

On physical examination, he was in acute distress, afebrile, anicteric, and not pale. Cardiovascular system examination revealed a regular rhythm with a rate of 90 bpm, and no radio-radial delay. He had normal first and second heart sounds with a loud A2 heard over the precordium. No murmurs or carotid bruits were appreciated. His blood pressure on the left arm was 109/66 mmHg and right arm 120/70 mmHg supine and standing positions. Respiratory rate was 24 breaths/ min and his chest was clear to auscultation and his temperature was 36°C. There were no neurological deficits. Laboratory findings were unremarkable. Electrocardiography and chest X-ray were normal. He was given a 500 mL intravenous normal saline bolus along with 325 mg aspirin. For his pain, he received 1mg hydromorphone IV and sublingual nitroglycerin, with subsequent decrease in pain to a 5/10 severity. Computed tomography angiography showed a 4·4 cm x 4·4 cm aneurysmal dilatation of the ascending thoracic aorta, with a type A dissection of the thoracic aorta extending from the aortic root (Figure 1) involving the entire thoracic aorta and upper abdominal aorta ending directly above the origin of the left renal artery. The dissection extended into the brachiocephalic artery and the proximal part of superior mesenteric artery (Figure 2). The patient was immediately transferred to the operating room per cardiothoracic surgeon recommendations on 12/13. During surgery, the aortic valve was interrogated and indicated only minimal aortic insufficiency and no frank aortic rupture; the tear site was found in the distal ascending aorta, proximal to the brachiocephalic artery. Under deep hypothermic circulatory arrest, repair was performed by transection of the aorta, hemiarch reconstruction, and aortic valve resuspension. A 30 mm graft was beveled and then sewn to the undersurface of the arch. Homeostasis was maintained during surgery with several rounds of blood products. Patient was then transferred to the intensive care unit for one day for close monitoring; he remained stable and then was transferred to the medical floor. He was then discharged on 12/17 to an extended care facility for cardiac rehabilitation and physical therapy for seven days; his stay was uncomplicated. He was subsequently discharged to home with plans to follow-up with cardiology.

Citation: Ridha A, Safiullah S, Al-Abayechi S, Ghadai A and Nadeem AUR. A Rare Presentation of a Life- Threatening Condition Secondary to Masturbatory Activity: A Case Report. J Cardiovasc Disord. 2015;2(2): 1012. ISSN: 2379-7991