Therapy

Discuss with cardiothoracic surgeon (and cardiologist) and organise transfer to a cardiothoracic unit or intensive care unit ^d

Meanwhile give antihypertensive therapy ^d . Options include ^d:

• labetalol iv
• nitroprusside and propranolol iv
• trimetaphan iv

Consider inserting 

• an intra-arterial line for constant bp monitoring if using nitroprusside or trimetaphan  ^d
• a urinary catheter  ^d

Aim  for systolic blood pressure of 100-120 mmHg provided the urine output >30 ml/ hour  ^d

• acute dissection of ascending aorta
• acute dissection of descending aorta with
  • signs of impending rupture (persisting pain, hypotension, left-sided haemothorax )
  • Marfan syndrome
• chronic dissection, if aorta > 5-6 cm in diameter or symptoms

• acute or chronic dissection of descending aorta ^d