Question

A 46-year-old woman presents to the emergency department with sudden onset severe tearing chest pain radiating to the back. Blood pressure is 190/110 mm Hg and ECG is normal. There is a new early diastolic murmur. Which immediate blood pressure strategy is most appropriate?

Accepted Answer

Heart rate and blood pressure control with intravenous beta blocker before vasodilator

Answer

Rapid reduction of systolic BP to less than 100 mm Hg using intravenous nitroprusside alone

Answer

Start high-dose oral ACE inhibitor and reassess in 2 hours

Answer

Administer sublingual nitroglycerin and discharge if pain settles

Answer

No blood pressure lowering until CT angiography is completed

Practice question

A 46-year-old woman presents to the emergency department with sudden onset severe tearing chest pain radiating to the back. Blood pressure is 190/110 mm Hg and ECG is normal. There is a new early diastolic murmur. Which immediate blood pressure strategy is most appropriate?