A 55-year-old man on ICU develops a hypertensive crisis (BP 240/140) with acute aortic regurgitation, pulmonary oedema, and a widened mediastinum on C...

Question

A 55-year-old man on ICU develops a hypertensive crisis (BP 240/140) with acute aortic regurgitation, pulmonary oedema, and a widened mediastinum on CXR. CT aortogram shows acute type A aortic dissection with the intimal flap extending into the aortic root. What class of antihypertensive must be given FIRST?

Accepted Answer

IV beta-blocker (esmolol or labetalol) - BEFORE any vasodilator, to reduce heart rate and dP/dt (rate of aortic pressure rise), preventing reflex tachycardia from vasodilators

Answer

IV sodium nitroprusside

Answer

IV hydralazine

Answer

IV nifedipine

Answer

Oral ACE inhibitor

uk-fficm MCQ (SBA): Aortic Dissection - Antihypertensive Order