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Type B Aortic Dissection — RACP Adult Medicine MCQ

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ModerateCardiologyType B Aortic DissectionRACP Adult Medicine

A 55-year-old man with a known thoracic aortic aneurysm (5.8 cm) presents with sudden onset severe chest pain. CT aortography shows a Stanford type B aortic dissection confined to the descending aorta. He is haemodynamically stable with no malperfusion. What is the recommended management?

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Correct answer: B — IV esmolol targeting HR <60 bpm and SBP 100–120 mmHg (medical management)

Uncomplicated Stanford type B aortic dissection (descending aorta only, no malperfusion, no rupture) is managed medically with aggressive blood pressure and heart rate control. IV beta-blocker (esmolol, labetalol) is first-line, targeting HR <60 bpm and SBP 100–120 mmHg. TEVAR is reserved for complicated type B dissection (malperfusion, rupture, refractory pain, rapid expansion). Long-term surveillance imaging is essential as late complications may develop.

Reference: eTG – 2025 – Cardiovascular; ESC – 2024 – Aortic Disease Guidelines