Aortic dissection and opioid use: Two autopsy cases and potential pathological implications

Acute aortic syndrome (AAS) is a life-threatening condition that includes acute aortic dissection (AAD), intramural hematoma (IMH), and symptomatic penetrating aortic ulcer. While hypertension is the primary risk factor, substance abuse—especially cocaine—has been linked to AAS. However, the role of opioids remains unclear. This study presents two autopsy cases of opioid users who died from cardiac tamponade due to aortic dissection. The first case involved a 55-year-old male undergoing methadone treatment, with biologically active methadone detected at death. The second case was a 58-year-old male with no known substance abuse history but with postmortem findings of morphine and methadone, indicating recent opioid use. Histological examination in both cases revealed vascular damage consistent with aortic dissection. While no direct causal link has been established, chronic opioid exposure may contribute to vascular degradation through hypoxia-inducible factor-1alpha (HIF-1α)-mediated inflammation. The overlap between opioid use and AAS in these cases suggests a potential association, warranting further investigation into the vascular effects of opioids and their clinical implications.