❤️ CardiologyCardiovascular / EmergencyStudentInternResident

Aortic Dissection

Also known as: dissecting aortic aneurysm · thoracic aortic dissection

A tear in the aortic intima with blood tracking within the wall — sudden, severe, tearing chest or interscapular back pain. A true emergency: type A (ascending) needs surgery; type B (descending) is often managed medically.

Source · Reviewed 2026-08-15 · v1.0— AI-assisted draft — verify against the cited guideline before clinical use.

⚕️ Education only — not medical advice. Verify against the latest official guideline and your local protocol; confirm every drug dose against the cited source before clinical use.

Who gets it

Hypertension (the biggest risk), connective-tissue disease (Marfan), bicuspid aortic valve, pregnancy, cocaine use and trauma.

Red flags — escalate / refer

A blood-pressure/pulse differential between arms, a new aortic-regurgitation murmur, tamponade, stroke, limb or organ ischaemia, or collapse → immediate emergency.

Work-up / diagnosis

1Urgent CT angiography of the aorta (or transoesophageal echo) to confirm and classify (Stanford A vs B).
2ECG and troponin to separate it from ACS (and to avoid thrombolysis); chest X-ray may show a widened mediastinum; compare BP in both arms.

Management — overview

Rapidly control heart rate and blood pressure — an IV beta-blocker first, then a vasodilator — with strong analgesia.
Type A (ascending) → emergency cardiothoracic surgery.
Type B (descending) → usually medical BP/HR control, with intervention for complications.
Avoid anticoagulation and thrombolysis.

In-depthFull dosing & advanced protocol

Drug dosing

IV beta-blocker, then vasodilator

Lower heart rate then blood pressure

Adult dose: Titrated to target heart rate/BP per protocol
Route: Intravenous

Caution: Control heart rate BEFORE the vasodilator (avoid reflex tachycardia); do NOT thrombolyse.

ICMRStandard Treatment Workflows (STWs), India — Dept. of Health Research & ICMR (2022+) ↗

Analgesia

Severe pain (reduces sympathetic drive)

Adult dose: Opioid per protocol
Route: Intravenous

WHOWHO Model List of Essential Medicines (electronic EML) (2025 (24th)) ↗

Type A vs B; think of it in atypical 'ACS'

Stanford type A goes to surgery; type B is usually medical unless complicated.
Suspect dissection in any 'ACS' with unequal pulses, a tearing quality, or radiation to the back.
Rate control precedes vasodilatation; thrombolysis is contraindicated.

ICMRStandard Treatment Workflows (STWs), India — Dept. of Health Research & ICMR (2022+) ↗

References

Guidelines change. If something here is out of date, tell us — we keep these current.

🚩 Report outdated / suggest update

More protocols

Acute Coronary Syndrome (incl. STEMI)Acute myocardial ischaemia — STEMI, NSTEMI or unstable angina. STEMI needs immediate reperfusion: “time is muscle”.Acute Heart FailureRapid onset or worsening of heart-failure symptoms — breathlessness, orthopnoea and oedema, often with pulmonary congestion. Relieve congestion and find the trigger.Hypertensive EmergencySevere blood-pressure elevation (usually >180/120 mmHg) WITH acute target-organ damage (brain, heart, kidney, retina). Needs controlled IV lowering — distinct from asymptomatic severe hypertension ('urgency').

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👤 Who gets it

🚩 Red flags — escalate / refer

🔎 Work-up / diagnosis

🧭 Management — overview

💊 Drug dosing

IV beta-blocker, then vasodilator

Analgesia

📈 Type A vs B; think of it in atypical 'ACS'

📚 References

More protocols

👤 Who gets it

🚩 Red flags — escalate / refer

🔎 Work-up / diagnosis

🧭 Management — overview

💊 Drug dosing

IV beta-blocker, then vasodilator

Analgesia

📈 Type A vs B; think of it in atypical 'ACS'

📚 References

More protocols

Who gets it

Red flags — escalate / refer

Work-up / diagnosis

Management — overview

Drug dosing

Type A vs B; think of it in atypical 'ACS'

References

Who gets it

Red flags — escalate / refer

Work-up / diagnosis

Management — overview

Drug dosing

Type A vs B; think of it in atypical 'ACS'

References