A man has abrupt tearing chest pain radiating to the back, a 30 mmHg difference in systolic pressure between the arms, and a widened mediastinum. Blood pressure is 190/110 mmHg. While arranging CT angiography, what is the priority drug treatment?
Answer and explanation
Correct answer: B. Intravenous beta-blocker to lower heart rate and shear
- Step 1: The history and findings point to aortic dissection. Step 2. Reducing heart rate and blood pressure reduces aortic wall stress, and a beta-blocker is given first so vasodilators do not cause reflex tachycardia. Answer: Intravenous beta-blocker to lower heart rate and shear. Why not the others: Thrombolysis and anticoagulants are potentially fatal in dissection. Hydralazine alone causes reflex tachycardia and increases shear.
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