Aortic Dissection: Impulse Control

• Tearing pain with a pulse deficit or widened mediastinum → urgent aortic imaging. Start IV β-blockade first (e.g., esmolol or labetalol) and titrate to HR 60–80/min. If SBP remains above target after heart-rate control, add an IV vasodilator. Target SBP <120 mm Hg or the lowest pressure that maintains adequate end-organ perfusion.
• Type A (any ascending) = emergency surgery; type B = medical unless malperfusion/rupture → TEVAR.
• Never thrombolyse this 'STEMI' mimic, and never vasodilate before β-blockade.
• An interarm SBP difference >20 mmHg or a new AR murmur increases pretest probability.

First tests: CT angiography of the aorta, 12-lead ECG, Full blood count, Sodium, potassium, bicarbonate, urea and creatinine, Blood group and crossmatch.

Only if indicated: Transesophageal echocardiography, D-dimer.

Repeat monitoring: Pulse, neurological, renal and perfusion assessment.

• Workup of Aortic Dissection
• Treating Aortic Dissection