Should nitroglycerin (NTG) be used for dissecting aortic aneurysm?

From the Guidelines

Nitroglycerin (NTG) should not be used as a first-line treatment for dissecting aortic aneurysm due to its potential to worsen the condition by causing reflex tachycardia. The primary goal in managing aortic dissection is to reduce blood pressure and decrease the force of cardiac contraction (dP/dt), which reduces shear stress on the aortic wall. While NTG does lower blood pressure, it primarily causes venodilation and can lead to reflex tachycardia, which may increase the force of cardiac contraction and potentially worsen the dissection. According to the most recent guidelines, such as those from the Acute Cardiovascular Care Association (ACCA) of the ESC 1, the treatment during transfer in suspected aortic dissection is limited to pain relief and blood pressure control, with a target heart rate and systolic blood pressure of <60 beats/min and 100–120 mmHg respectively. Some studies suggest that intravenous beta-blockers, nitrates, sodium nitroprusside, or calcium channel blockers are adequate options for blood pressure control 1. However, beta-blockers should be started before other anti-hypertensive drugs in order to avoid reflex tachycardia. Key points to consider in the management of dissecting aortic aneurysm include:

• Reducing blood pressure and heart rate to decrease shear stress on the aortic wall
• Using beta-blockers as the first-line treatment to reduce heart rate and blood pressure
• Avoiding reflex tachycardia by starting beta-blockers before other anti-hypertensive drugs
• Considering the use of vasodilators like sodium nitroprusside if additional blood pressure control is needed after beta-blockade. It is essential to prioritize the reduction of morbidity, mortality, and improvement of quality of life in the management of dissecting aortic aneurysm, and the use of NTG is not recommended as a first-line treatment due to its potential to worsen the condition 1.

From the Research

Dissecting Aortic Aneurysm Treatment

The use of nitroglycerin (NTG) for dissecting aortic aneurysm is not directly addressed in the provided studies. However, the following points can be considered:

• The treatment of dissecting aneurysms often involves surgical or endovascular interventions, as seen in studies 2, 3, 4.
• The management of dissecting aneurysms may involve the use of various medications, but the specific use of NTG is not mentioned in the provided studies.
• Study 5 discusses the use of dihydropiridine calcium-channel blockers in aortic aneurysm surgery, but does not address the use of NTG.
• Study 6 compares early surgery versus conservative management of dissecting aneurysms of the descending thoracic aorta, but does not mention the use of NTG.

Key Considerations

Some key considerations in the treatment of dissecting aortic aneurysms include:

• The type and location of the aneurysm, as well as the patient's overall health and risk factors 3, 4, 6.
• The potential benefits and risks of surgical or endovascular interventions, as well as medical therapy 2, 3, 4, 6.
• The importance of individualized treatment plans, taking into account the patient's specific needs and circumstances 6.

Treatment Options

Some treatment options for dissecting aortic aneurysms include:

• Surgical repair, such as open heart surgery or endovascular repair 2, 3, 4.
• Medical therapy, such as the use of blood pressure medications or other medications to manage symptoms and prevent complications 5, 6.
• Endovascular interventions, such as stent placement or coil embolization 2, 4.