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Emergency
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hard
Suspected Aortic Dissection
Flowchart
Play
Tearing pain, pulse deficit, BP differential — image with CTA or TEE.
Decision
Outcome
Decision
Tearing chest/back pain + pulse deficit, BP differential >20 mm Hg, or AR murmur. First step?
✓
Chest X-ray + ECG to look for mimics (STEMI, pneumothorax)
✗
Immediate thrombolytics
Decision
Mimics excluded. Definitive imaging?
✓
Stable, normal Cr, no allergy → CT angiogram of chest/abdomen/pelvis
✓
Unstable / renal failure / contrast allergy → TEE at bedside
✗
MRI on every patient
Outcome
Initial medical therapy then surgical decision by type
Lower HR (target 60) with IV β-blocker (esmolol, labetalol) BEFORE vasodilators to avoid reflex tachycardia. Then SBP 100–120 with nitroprusside or nicardipine. Type A (ascending) → emergent surgery. Type B (descending) → medical management; TEVAR if malperfusion/rupture.