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(Circulation. 2003;108:772.)
© 2003 American Heart Association, Inc.

Review: Clinical Cardiology: New Frontiers

Aortic Dissection: New Frontiers in Diagnosis and Management

Part II: Therapeutic Management and Follow-Up

Christoph A. Nienaber, MD; Kim A. Eagle, MD

From the Division of Cardiology at the University Hospital Rostock (C.A.N.), Rostock School of Medicine, Rostock, Germany, and the Division of Cardiology at the University of Michigan (K.A.E.), Ann Arbor, Mich.

Correspondence to Christoph A. Nienaber, MD, FACC, Division of Cardiology, University Hospital Rostock, Rostock School of Medicine, Ernst-Heydemann-Str. 6, 18057 Rostock, Germany. E-mail christoph.nienaber@med.uni-rostock.de

Key Words: aorta • aneurysm • stents • surgery • cardiovascular diseases

An extract of the first 250 words of the full text is provided, because this article has no abstract.

Cardiovascular disease is the leading cause of death in most Western societies and is increasing steadily in many developing countries. Aortic diseases constitute an emerging share of the burden. New diagnostic imaging modalities, longer life expectancy in general, longer exposure to elevated blood pressure, and the proliferation of modern noninvasive imaging modalities have all contributed to the growing awareness of acute and chronic aortic syndromes. Despite recent progress in recognition of both the epidemiological problem and diagnostic and therapeutic advances, the cardiology community and the medical community in general are far from comfortable in understanding the spectrum of aortic syndromes and defining an optimal pathway to manage aortic diseases.^1–13 This comprehensive review is organized in two parts, with focus on etiology, natural history, and classification (with vascular staging) of aortic wall disease in Part I and emphasis on therapeutic management and follow-up in Part II. Both parts may help to better integrate the complexities of acute aortic syndromes.

V. Therapeutic Management

Medical Treatment
Patients with suspected acute aortic dissection should be admitted to an intensive care or monitoring unit and undergo diagnostic evaluation immediately. Pain and blood pressure control to a target systolic pressure of 110 mm Hg can be achieved using morphine sulfate and intravenous ß-blockers (metoprolol, propranolol, or labetalol) or in combination with vasodilating drugs such as sodium nitroprusside or angiotensin-converting enzyme inhibitors. Intravenous verapamil or diltiazem may also be used, especially if ß-blockers are contraindicated. Monotherapy with ß-blocking agents may be adequate to control mild hypertension, and in concert with sodium nitroprusside . . . [Full Text of this Article]

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