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Emerg Med J doi:10.1136/emermed-2012-202162
  • Images in emergency medicine

Roller coasters: a source of fun and tears

  1. Scot Garg1
  1. 1Cardiology Department, Royal Blackburn Hospital, Blackburn, UK
  2. 2Cardiovascular Research Group, University of Manchester, Manchester, UK
  3. 3Radiology Department, Royal Blackburn Hospital, Blackburn, UK
  1. Correspondence to Dr Scot Garg, Cardiology Department, Royal Blackburn Hospital, Haslingden Road, Blackburn BB2 3HH, UK; scot.garg{at}elht.nhs.uk
  • Received 14 November 2012
  • Revised 14 November 2012
  • Accepted 21 November 2012
  • Published Online First 12 January 2013

A previously fit 43-year-old man presented with sudden onset, severe, tearing intrascapular chest pain one day after visiting an amusement park where he had engaged in a number of high-speed rides. Examination was unremarkable apart from a prominent diastolic murmur; blood pressure was 144/61 mm Hg. There was biochemical evidence of acute renal failure and microscopic haematuria. His electrocardiogram showed non-specific infero-lateral T-wave changes. Urgent trans-thoracic echocardiography (figure 1) demonstrated evidence of a dissection involving the ascending aorta and severe aortic regurgitation; a subsequent CT (figure 2A–C) confirmed the presence of a Stanford A, DeBakey I aortic dissection. He was transferred to the regional aortic centre where he underwent successful repair of the ascending aorta, with resuspension of his native aortic valve. A residual thoraco-abdominal aorta dissection will be kept under surveillance.

Figure 1

Echocardiography in parasternal view. The aortic root is dilated (3.8 cm at the sinuses of Valsalva), which was associated with severe aortic regurgitation.

Figure 2

Contrast CT scan. The dissection originated in the root of the ascending aorta, involving the entire arch, thoracic and abdominal aorta ending in the right common iliac artery (A). There was evidence of a dissection extending to the right common carotid artery; however, the left was unaffected (B). The right renal artery arose from the false lumen and showed reduced enhancement and function subsequent to this (C). Incidentally, a secondary deep vein thrombosis (DVT) within the right common iliac vein was noted.

The acceleration, deceleration and rotational forces experienced during a roller-coaster ride have been associated with dissections in carotid and vertebral arteries, subdural haematomas and subarachnoid haemorrhages.1 The possible mechanism of injury includes damage to the arterial vessel wall intima due to the high G and rotational forces generated by roller coasters; however, the human G-force threshold for these injuries remains undetermined. Practitioners should be wary of potentially serious acceleration/deceleration injuries in patients presenting after being on roller-coaster rides.

Footnotes

  • Patient consent Obtained.

  • Contributors SGA and SG were responsible for the drafting of the manuscript and TN, SGA, TKL and SG for the interpretation of the results.

  • Competing interests None.

  • Provenance and peer review Not commissioned; internally peer reviewed.

Reference


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