Aortic Dissection (cont.)
Benjamin Wedro, MD, FACEP, FAAEM
Dr. Ben Wedro practices emergency medicine at Gundersen Clinic, a regional trauma center in La Crosse, Wisconsin. His background includes undergraduate and medical studies at the University of Alberta, a Family Practice internship at Queen's University in Kingston, Ontario and residency training in Emergency Medicine at the University of Oklahoma Health Sciences Center.
Melissa Conrad Stöppler, MD
Melissa Conrad Stöppler, MD, is a U.S. board-certified Anatomic Pathologist with subspecialty training in the fields of Experimental and Molecular Pathology. Dr. Stöppler's educational background includes a BA with Highest Distinction from the University of Virginia and an MD from the University of North Carolina. She completed residency training in Anatomic Pathology at Georgetown University followed by subspecialty fellowship training in molecular diagnostics and experimental pathology.
In this Article
- Aortic dissection facts
- Introduction to aortic dissection
- What are the causes of aortic dissection?
- What are the signs and symptoms of aortic dissection?
- How is aortic dissection diagnosed?
- What is the treatment for aortic dissection?
- What is the prognosis for aortic dissection?
- Can aortic dissection be prevented?
What is the treatment for aortic dissection?
The ABCs of resuscitation are always a priority.
In the emergency department, intravenous lines will be placed, monitors for heart rate and rhythm will be attached, and supplemental oxygen provided. Treatment and diagnostic testing usually occur at the same time until the final diagnosis is established and definitive treatment is required.
The initial medications used for treatment of an aortic dissection are directed at lowering the blood pressure to prevent further tearing or damage to the aorta. Beta blocker medications (for example, esmolol [Brevibloc], labetalol [Normodyne, Trandate], metoprolol [Lopressor, Toprol XL]) decrease the adrenaline action on the heart and blood vessels. Nitroglycerin dilates blood vessels to decrease blood pressure. These medications cannot be used if the patient is in shock with low blood pressure because of the aortic dissection. Specific medication combinations will depend upon the patient's needs.
Ultimately, type A aortic dissections of the ascending aorta require surgery as the treatment of choice. The area of the aorta that is damaged is replaced with an artificial graft. If the aortic valve has been damaged, it too may need replacement or repair.
Medical management (nonsurgical) is usually preferred for type B dissection of the descending aorta, but again, each patient needs to be assessed individually as to the specific treatment suggested. Medications are prescribed to aggressively control high blood pressure to prevent further dissection and aortic injury.
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