Acute aortic syndromes — Rapid | Doctor's Passport Education

Synopsis

Recognise aortic dissection, intramural haematoma and penetrating aortic ulcer early; obtain definitive imaging; begin safe anti-impulse therapy and trigger immediate aortic-team treatment.

Acute aortic syndromes comprise classic dissection, intramural haematoma and penetrating atherosclerotic ulcer; each may rupture or cause branch-vessel malperfusion.
Stanford type A involves the ascending aorta; type B does not. The classification predicts the immediate treatment pathway.
Think of AAS when severe chest, back or abdominal pain is abrupt and maximal at onset, especially with a pulse/BP deficit, focal neurology, syncope, shock or new aortic regurgitation.

Key red flags

High-risk pain

Abrupt, severe pain maximal at onset in the chest, interscapular back or abdomen; pain may migrate as dissection extends. Painless presentations occur, especially with syncope or neurological deficit.

Investigation priorities

Immediate ABCDE assessment, both-arm BP and complete pulse/neurological examinationFirst step

Identify shock, tamponade, acute AR and dynamic malperfusion while preparing definitive imaging.

ECG-gated CT angiography from neck to pelvisPreferred

Preferred rapid anatomical test in most suspected AAS.

Management branches

Immediate / protocol-dependentSuspected AAS before anatomy is known

Credible high-risk pain, history or examination feature.

Activate emergency, aortic/cardiothoracic, anaesthetic and critical-care pathways; use two large-bore IVs, continuous ECG, oxygen saturation and frequent BP, with an arterial line when expertise is available.
Give titrated IV opioid analgesia and obtain urgent ECG-gated CTA neck-to-pelvis; use bedside TOE if too unstable for CT. Inform the receiving aortic centre early and do not delay transfer for nonessential tests.

Preferred interventionStanford type A

Any acute syndrome involving the ascending aorta, including dissection or intramural haematoma.

Key medicines

Labetalol IV50 mg IV over at least 1 minute, often over 1–2 minutes; repeat after 5 minutes if necessary to a usual maximum cumulative 200 mg. A specialist infusion around 15–20 mg/hour may be titrated to target.

Esmolol IV500 micrograms/kg/min for 1 minute, then 50 micrograms/kg/min for 4 minutes; if needed repeat the loading dose and increase maintenance stepwise to 100, 150 then 200 micrograms/kg/min at 5-minute intervals.

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