What is the incorrect treatment for an aortic dissection among the following options: an arterial line is rarely required, goal Systolic Blood Pressure (SBP) is less than 120 mmHg, use metoprolol (metoprolol) if the patient is experiencing tachycardia, never give nitropride (nitroprusside) to a post-surgical patient?

From the Guidelines

The false statement about aortic dissection treatment is "Goal SBP is at least <120 mmHg" because the goal systolic blood pressure should be below 120 mmHg, not at least. In reality, the management of aortic dissection involves precise blood pressure control, with a goal systolic blood pressure typically below 120 mmHg to reduce shear forces on the aortic wall, as recommended by the 2022 ACC/AHA guideline for the diagnosis and management of aortic disease 1. Metoprolol is indeed appropriate for tachycardic patients as beta-blockers help reduce heart rate and contractility, decreasing stress on the aorta. Regarding sodium nitroprusside (Nipride), it should be used cautiously in post-surgical patients but isn't absolutely contraindicated - it's often used with beta-blockers when additional blood pressure control is needed, as suggested by the 2018 ACC/AHA/AAPA/ABC/ACPM/AGS/APhA/ASH/ASPC/NMA/PCNA guideline for the prevention, detection, evaluation, and management of high blood pressure in adults 1. An arterial line is commonly used in managing aortic dissections because it provides continuous blood pressure monitoring, which is essential for these patients, as stated in the 2022 ACC/AHA guideline for the diagnosis and management of aortic disease 1. Key points to consider in the management of aortic dissection include:

• The use of beta-blockers as first-line treatment to reduce heart rate and contractility
• The goal of achieving a systolic blood pressure below 120 mmHg
• The importance of continuous invasive blood pressure monitoring through an arterial line
• The cautious use of sodium nitroprusside in post-surgical patients. Overall, the management of aortic dissection requires careful consideration of these factors to reduce morbidity, mortality, and improve quality of life, as emphasized by the 2019 ESC Council on Hypertension position document on the management of hypertensive emergencies 1.

From the Research

Treatment Options for Aortic Dissection

The following points highlight the treatment options for aortic dissection:

• An arterial line is often required for close monitoring of blood pressure in patients with aortic dissection.
• The goal systolic blood pressure (SBP) is typically less than 120 mmHg to reduce the risk of further dissection or rupture 2.
• Beta-blockers, such as metoprolol, are commonly used to control heart rate and blood pressure in patients with aortic dissection, especially if they are tachycardic 3, 4.
• Sodium nitroprusside can be used in conjunction with beta-blockers to control blood pressure, but its use may be limited in certain patients, such as those with renal impairment or those who are at risk of cyanide toxicity 3, 5.

False Treatment Option

The false treatment option for aortic dissection is:

• Never give nitroprusside to a post-surgical patient: This statement is not entirely accurate, as nitroprusside can be used in post-surgical patients with aortic dissection, but its use should be carefully considered and monitored due to the potential risks 3, 5.
• Goal SBP is at least <120 mmHg: This statement is also false, as the goal SBP is typically less than 120 mmHg, not at least <120 mmHg 2.
• An arterial line is rarely required: This statement is false, as an arterial line is often required for close monitoring of blood pressure in patients with aortic dissection. Note that the provided evidence does not directly support the other options as false treatment options for aortic dissection 6, 3, 2, 5, 4.