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Aortic Dissection — RACP Adult Medicine MCQ

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HardCardiologyAortic DissectionRACP Adult Medicine

A 65-year-old has CT-confirmed Stanford type A aortic dissection, blood pressure 190/110 mmHg and no tamponade. While immediate surgical transfer is arranged, which anti-impulse sequence is appropriate?

Educational content. Not a substitute for clinical judgement or local policy.

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Correct answer: E — Give an IV beta blocker first, then add a titratable vasodilator if blood pressure remains high

The best answer is “Give an IV beta blocker first, then add a titratable vasodilator if blood pressure remains high”. A short-acting IV beta blocker reduces heart rate and the force of ventricular ejection; a vasodilator can then be added if pressure remains above target. Vasodilator monotherapy can provoke reflex tachycardia and increase shear stress. Hypotension, delayed oral titration and thrombolysis are dangerous. Analgesia and emergency cardiothoracic surgery are integral to care.

Reference: Heart Foundation: Australian clinical guidelines and position statements: https://www.heartfoundation.org.au/for-professionals/clinical-guidelines-position-statements ACC/AHA: 2022 aortic disease guideline: https://www.acc.org/Guidelines/Guidelines/2022/11/02/14/08/Aortic-Disease