ICU · Cardiovascular / aortic

Acute Aortic Syndromes — Dissection

Also known as Acute aortic syndrome · Aortic dissection · Stanford classification · Type A dissection · Type B dissection · Intimal flap · TEVAR · Malperfusion

Acute aortic dissection is classified by the Stanford system: Type A (involving the ascending aorta — a surgical emergency with a high risk of rupture, tamponade, aortic regurgitation, and stroke) and Type B (descending aorta, distal to the left subclavian — managed medically with aggressive BP control). The classic presentation is a tearing chest or back pain, maximal at onset, with a pulse deficit or a new aortic regurgitation murmur. The diagnosis is by CT angiography (the intimal flap, the true and the false lumen). Type A requires urgent surgery; Type B is managed with a beta-blocker FIRST (to control the heart rate and the sheer stress), then a vasodilator (to lower the BP to an SBP under 120). Never give a vasodilator without a beta-blocker first — the reflex tachycardia worsens the dissection.