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Type A Dissection Emergency — EECC MCQ

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ModerateGeneral CardiologyType A Dissection EmergencyEECC

A 55-year-old man with known BAV develops acute severe chest pain. CT aortography shows a Stanford type A dissection extending from the ascending aorta to the descending aorta. He is haemodynamically stable. What is the immediate management?

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Correct answer: C — Emergency surgical repair of the ascending aorta — type A dissection involving the ascending aorta is a surgical emergency with >1% per hour mortality if untreated; IV beta-blocker to target HR <60 and SBP 100-120 mmHg while preparing for surgery

Type A aortic dissection (involving the ascending aorta, regardless of distal extension) is a surgical emergency. Without surgery, mortality is approximately 1-2% per hour in the first 48 hours. The ESC 2024 Aortic Disease Guidelines recommend: (1) emergency surgical repair (replacement of the ascending aorta ± aortic root ± arch, with reimplantation of coronary arteries if dissected); (2) immediate medical therapy while preparing for surgery: IV beta-blocker (esmolol or labetalol) to reduce HR <60 bpm and SBP 100-120 mmHg (reducing aortic wall shear stress/dP/dt); add IV nitroprusside if needed after beta-blockade. TEVAR has no role in isolated ascending aortic dissection (no landing zone). Complications requiring urgent surgical management include: aortic regurgitation, coronary malperfusion, tamponade, and malperfusion syndromes.

Reference: ESC (2024): Aortic Disease Guidelines