The Goal of Treatment :-
• Reduces the Force of Cardiac Contraction
• Reduces Rate of Rise of Aortic pressure (dP/dt)
• Retards Propagation of Dissection and
• Delays Aortic Rupture.
Target of Acut Treatment
Target Heart Rate should be
60 - 80 beats per minute.
Target Systolic Blood Pressure should be
100 - 120 mm Hg.
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To Reduce dP/dt Acutely:-
Administer IV beta blocker in incremental doses
Uٓntil a HR of 60-80 is attained.
Consider Calcium channel blockers
When Beta Blockers are Not available or
contraindicated, such as in advanced AV Block
Beta-blockers should be used cautiously
with Aortic Regurgitation because
they will block compensatory tachycardia
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To Reduce Arterial Pressure Acutely :-
Sodium Nitroprusside is effective and potent Vasodilator
Vasodilator therapy should not be initiated
prior to rate control to avoid associated
reflex tachycardia
ACEI successfully Treats Refractory HTN
associated aortic dissection.
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IV Morphine sulfate prevent exacerbations of
Tachycardia and HTN
Stanford classification delineate treatment
• Type A (Ascending Ao) requires Surgical ttt
• Type B does not involve-requires Medical ttt
Before administering Thrombolytics
Checking blood pressures in both arms and
listening for carotid bruits also can help to
Exclude aortic dissection