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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