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Question

You have a patient in the ED with an aortic dissection and are managing them while awaiting the cardiovascular surgeon to arrive.

1. What are the two most important things to control?
2. How do you go about doing that?

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Answer

1. The main aims of acute medical management of aortic dissections are to decrease the rate of left ventricular contraction and decrease the velocity of the contraction, which will overall decrease the shear stress at the site of the tear and slow progression.
2. Start with intravenous beta-blockade and titrate to a heart rate of 60 betas/minute
   

1. If systolic blood pressure is > 120 mmHg after successful beta-blockade, then add a vasodilator or afterload reducer.

For a deep dive into aortic dissections, check out the podcast

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References

1. Hiratzka LF, Bakris GL, Beckman JA, et al. 2010 ACCF/AHA/AATS/ACR/ASA/SCA/SCAI/SIR/STS/SVM guidelines for the diagnosis and management of patients with Thoracic Aortic Disease: a report of the American College of Cardiology Foundation/American Heart Association Task Force on Practice Guidelines, American Association for Thoracic Surgery, American College of Radiology, American Stroke Association, Society of Cardiovascular Anesthesiologists, Society for Cardiovascular Angiography and Interventions, Society of Interventional Radiology, Society of Thoracic Surgeons, and Society for Vascular Medicine. Circulation. 2010; 121(13):e266-369. [pubmed]
2. Tsai TT, Nienaber CA, Eagle KA. Acute aortic syndromes. Circulation. 2005; 112(24):3802-13. [pubmed]