Action
- Obtain emergent cardiothoracic consult (Class I)
- Perform imaging:
- CTA
- TEE
- MRI/MRA
- Angiography
Decision
Is aortic dissection, penetrating atherosclerotic ulcer, or intramural hematoma diagnosed?
Yes
- Obtain emergent cardiothoracic consult (Class I)
- Hypertensive: (Class II)
- Control heart rate: IV beta blocker or calcium-channel blocker (goal heart rate ≤60 beats/min
- Control blood pressure: IV nicardipine, nitroprusside, clevidipine (goal SBP 100-120 mm Hg)
- For type A aortic dissection:
- Open repair (Class I)
- Endovascular aortic repair if high operative risk (Class II)
- For type B aortic dissection:
- Uncomplicated: Perform endovascular aortic repair vs medical management (Class II)
- Complicated: Perform endovascular aortic repair (Class II)
No
- If clinical suspicion persists, consider additional imaging
