Aortic Dissection
Cardiovascular · ~11% of blueprint- Pathophysiology
- Intimal tear → blood tracks into the media → false lumen propagation. Risk: HTN, Marfan/connective-tissue disease, bicuspid valve, cocaine.
- Signs & Symptoms
- Sudden tearing/ripping chest pain radiating to the back; inter-arm BP differential; may cause AR murmur, tamponade, stroke, or limb ischemia.
- Gold Standard Diagnosis
- CT angiography (stable patient); TEE if unstable. Widened mediastinum on CXR is a clue.
- First-line Treatment
- Stanford A (ascending) → emergent surgery. Stanford B (descending) → medical: IV beta-blocker (esmolol) to lower HR/BP FIRST, then a vasodilator.
High-Yield Pearl
Beta-blocker BEFORE vasodilator (avoid reflex tachycardia → ↑ shear stress). Type A = surgery, Type B = medical unless complicated.
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Gross Anatomy
Physiology
Sources
Reviewed September 2026- 2022 ACC/AHA Guideline for the Diagnosis and Management of Aortic Disease — ACC/AHA, 2022
- StatPearls: Aortic Dissection — NCBI Bookshelf / StatPearls, 2025
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