- 🔬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.