This handout is for aortic dissection (stanford a / b + imh / pau). Your care team identified this based on: tearing / migrating chest or back pain (acc/aha 2022 isselbacher — classic presentation; irad hagan jama 2000).
Other reasons your team may use this plan: inter-arm sbp gradient ≥20 mmhg (acc/aha 2022 isselbacher; esc 2024); syncope with chest/back pain (acc/aha 2022 — high-risk feature); cta showing aortic dissection / imh / pau (acc/aha 2022 class i imaging).
Take these medications exactly as prescribed. Do not stop or change a dose without talking to your provider.
| Medication | Starting dose | How | When | What it does |
|---|---|---|---|---|
| esmolol | 500 µg/kg IV bolus → 50 µg/kg/min, titrate by 50 q5min | IV | continuous | 2022 ACC/AHA — short half-life ideal for titration; lower target HR before vasodilator |
| labetalol | 20 mg IV bolus q10min, max 300 mg, then 0.5–2 mg/min infusion | IV | continuous | Combined α+β blockade — vasodilation without reflex tachy (ACC/AHA 2022) |
Plan: Anti-impulse therapy + syndrome-specific repair (ACC/AHA 2022)
Call 911 or go to the nearest emergency room right away if you have:
Guideline: 2022 ACC/AHA Guideline for Diagnosis and Management of Aortic Disease (Isselbacher) + IRAD registry + INSTEAD-XL + ADSORB type-B dissection evidence