Thoracic aortic disease medical therapy

ACC/AHA Guidelines - Guidelines for the Diagnosis and Management of Patients With Thoracic Aortic Disease (DO NOT EDIT)

Class I Recommendations for Initial Management

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1. Initial management of thoracic aortic dissection should be directed at decreasing aortic wall stress by controlling heart rate and blood pressure as follows: a. In the absence of contraindications, intravenous beta blockade should be initiated and titrated to a target heart rate of 60 beats per minute or less. (Level of Evidence: C) b. In patients with clear contraindications to beta blockade, nondihydropyridine calcium channel blocking agents should be used as an alternative for rate control. (Level of Evidence: C) c. If systolic blood pressures remain greater than 120 mm Hg after adequate heart rate control has been obtained, then angiotensin-converting enzyme inhibitors and/or other vasodilators should be administered intravenously to further reduce blood pressure that maintains adequate end-organ perfusion. (Level of Evidence: C) d. Beta blockers should be used cautiously in the setting of acute aortic regurgitation because they will block the compensatory tachycardia. (Level of Evidence: C)

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Class III Recommendations for Initial Management

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1. Vasodilator therapy should not be initiated prior to rate control so as to avoid associated reflex tachycardia that may increase aortic wall stress, leading to propagation or expansion of a thoracic aortic dissection. (Level of Evidence: C)

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