Thoracic aortic disease medical therapy

ACC/AHA Guidelines - Guidelines for the Evaluation and Management of acute Thoracic aortic disease (DO NOT EDIT)

Class I Recommendations

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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Definitive management

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1. Urgent surgical consultation should be obtained for all patients diagnosed with thoracic aortic dissection regardless of the anatomic location (ascending versus descending) as soon as the diagnosis is made or highly suspected. (Level of Evidence: C) 2. Acute thoracic aortic dissection involving the ascending aorta should be urgently evaluated for emergent surgical repair because of the high risk of associated life-threatening complications such as rupture. (Level of Evidence: B) 3. Acute thoracic aortic dissection involving the descending aorta should be managed medically unless life-threatening complications develop (eg, malperfusion syndrome, progression of dissection, enlarging aneurysm, inability to control blood pressure or symptoms). (Level of Evidence: B)

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Class III Recommendations

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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Class IIa Recommendations

Aortic arch and Thoracic aortic atheroma and atheroembolic Disease

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1. Treatment with a statin is a reasonable option for patients with aortic arch atheroma to reduce the risk of stroke. (Level of Evidence: C)

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Class IIb Recommendations

Aortic arch and Thoracic aortic atheroma and atheroembolic Disease

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1. Oral anticoagulation therapy with warfarin (INR 2.0 to 3.0) or antiplatelet therapy may be considered in stroke patients with aortic arch atheroma 4.0 mm or greater to prevent recurrent stroke. (Level of Evidence: C)

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ACC/AHA Guidelines - Recommendation for Medical Treatment of Patients With Thoracic Aortic Diseases (DO NOT EDIT)

Class I Recommendations

Medical treatment

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1. Stringent control of hypertension, lipid profile optimization, smoking cessation, and other atherosclerosis risk-reduction measures should be instituted for patients with small aneurysms not requiring surgery, as well as for patients who are not considered to be surgical or stent graft candidates. (Level of Evidence: C)

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