Uncomplicated Type B Dissection Management — EECC MCQ

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ModerateAortic DiseaseUncomplicated Type B Dissection ManagementEECC

A 58-year-old man with acute type B aortic dissection (descending aorta only) is haemodynamically stable with controlled pain and BP. There is no malperfusion syndrome. What is the initial management?

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Correct answer: A — Optimal medical therapy: IV beta-blocker to target HR <60 bpm and SBP 100-120 mmHg, with morphine for pain control and close ICU monitoring — uncomplicated type B dissection is managed medically as first-line

Uncomplicated acute type B aortic dissection (Stanford B — not involving the ascending aorta) is initially managed medically. The ESC 2024 Aortic Disease Guidelines recommend: (1) IV beta-blocker (esmolol/labetalol) — target HR <60 bpm to reduce aortic wall shear stress (dP/dt); (2) SBP target 100-120 mmHg (add nitroprusside after beta-blockade if needed); (3) adequate analgesia (morphine — pain drives sympathetic activation, increasing HR and BP); (4) ICU monitoring for complications. TEVAR is indicated for complicated type B dissection: malperfusion (renal, visceral, limb ischaemia), rupture, rapid expansion, persistent pain despite medical therapy, or refractory hypertension. The INSTEAD-XL trial showed potential benefit of pre-emptive TEVAR in uncomplicated type B at 2-5 years, but this remains debated and is a Class IIa recommendation for selected patients.

Reference: ESC (2024): Aortic Disease Guidelines