From the Guidelines
If aortic dissection is suspected, immediate actions include stabilizing the patient, controlling blood pressure and heart rate, and transferring to a cardiac center. The management of aortic dissection prioritizes reducing shear forces on the aorta to prevent further dissection and rupture, which are associated with high morbidity and mortality rates 1. Key actions include:
- Administering IV beta-blockers such as labetalol or esmolol to target a heart rate below 60 bpm, as recommended by recent guidelines 1.
- Adding vasodilators like nicardipine or nitroprusside if blood pressure remains elevated after heart rate control, with a target systolic blood pressure between 100-120 mmHg 1.
- Providing adequate analgesia with IV morphine or fentanyl to reduce pain and sympathetic drive, which can exacerbate the dissection 1.
- Obtaining urgent imaging with CT angiography, transesophageal echocardiography, or MRI to confirm diagnosis and guide management, as emphasized by recent studies 1.
- Avoiding thrombolytics and anticoagulants, which can worsen the dissection, and considering immediate surgical consultation for Type A dissections involving the ascending aorta, while Type B dissections may be managed medically 1. These interventions aim to stabilize the tear, prevent extension of the dissection, and reduce the risk of complications such as aortic rupture, which carries a high mortality rate if not promptly addressed 1.
From the Research
Immediate Actions for Suspected Aortic Dissection
If aortic dissection is suspected, the following actions need to be taken:
- Immediate imaging with chest computed tomography scan followed by transthoracic echocardiography (TTE) to confirm diagnosis 2
- Controlling the heart rate (60-80 beats/min), systolic blood pressure (100-120 mmHg) and pain as part of immediate medical management 2
- Referral to cardiothoracic surgeons for emergency aortic surgery for patients with Type A acute aortic dissection 2, 3
- Referral to vascular surgeons for surgical/endovascular interventions if indicated for patients with Type B acute aortic dissection 2
- Urgent surgical intervention should be considered in all patients with acute type A aortic dissection, with individualized decision-making for each patient 3