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Aortic Dissection — RACP Adult Medicine MCQ

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ModerateEmergency MedicineAortic DissectionRACP Adult Medicine

A 42-year-old man presents to the emergency department with sudden onset severe tearing chest pain radiating to the back. His BP is 210/120 mmHg in the right arm and 170/90 mmHg in the left arm. CT aortography shows a Stanford type A aortic dissection. What is the definitive management?

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Correct answer: B — Emergency surgical repair

Stanford type A aortic dissection (involving the ascending aorta) requires emergency surgical repair due to the high risk of complications including aortic rupture, pericardial tamponade, acute aortic regurgitation, and coronary malperfusion. While awaiting surgery, IV beta-blockade (esmolol or labetalol) targeting HR <60 bpm and SBP 100–120 mmHg is essential. Type B dissections (descending aorta only) are generally managed medically unless complicated.

Reference: eTG – 2025 – Cardiovascular; CSANZ – 2022 – Aortic Disease Guidelines