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Type A Aortic Dissection — EECC MCQ

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HardAortic DiseaseType A Aortic DissectionEECC

A 65-year-old man presents with sudden-onset tearing chest pain radiating to the back. CT aortogram confirms Stanford type A aortic dissection. He is haemodynamically stable with BP 160/95 mmHg and heart rate 90 bpm. There is no aortic regurgitation, tamponade, or malperfusion. What is the most appropriate management?

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Correct answer: D — Urgent medical management with IV labetalol targeting HR below 60 bpm and SBP below 120 mmHg, followed by surgical repair

Explanation lettering: C = shown as A · E = shown as C · A = shown as D · D = shown as E

Stanford type A aortic dissection is a surgical emergency. Emergency surgical repair is recommended (Class I). While awaiting surgery, aggressive IV beta-blockade targeting HR below 60 bpm and SBP below 120 mmHg is essential. Medical therapy alone (B) is for uncomplicated type B dissection. TEVAR (C) is for complicated type B. Coronary angiography (D) would delay surgery. Outpatient review (E) is dangerously delayed.

Reference: ESC (2024): Guidelines for the Management of Peripheral Arterial and Aortic Diseases