Aortic Dissection BP Target — RACP Adult Medicine MCQ

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HardCardiologyAortic Dissection BP TargetRACP Adult Medicine

A 60-year-old man presents with sudden severe tearing chest pain radiating to the back, BP 220/130 mmHg in the right arm and 180/100 in the left arm. CT aortography shows a Stanford type B aortic dissection (descending aorta only, beyond left subclavian). He has no malperfusion syndrome. What is the target BP?

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Correct answer: C — SBP <120 mmHg and HR <60 bpm within 20 minutes

Acute aortic dissection requires aggressive BP and HR control: target SBP <120 mmHg AND HR <60 bpm within 20 minutes. IV beta-blocker (esmolol or labetalol) is first-line (reduces aortic wall shear stress by lowering both BP and dP/dt). Vasodilators (GTN, nitroprusside) should only be added AFTER adequate beta-blockade to prevent reflex tachycardia. Uncomplicated type B: medical management. Complicated type B: endovascular repair (TEVAR).

Reference: ESC – 2024 – Aortic Disease; CSANZ 2024