AMBOSS 200 High Yield Concepts for Step 2 Practice Test 2026 – Your All-in-One Guide to Exam Success!

Acute aortic dissection must be treated first by halting the forces that drive the tear. The primary step is hemodynamic control to reduce shear stress on the aortic wall. Administer an IV beta-blocker to lower the heart rate and the systolic blood pressure—gentle but rapid reduction in both helps prevent propagation of the dissection. Esmolol or labetalol are typical choices because they blunt the rate of rise in pressure (dP/dt) and decrease the force pushing the dissection walls apart. After beta-blockade, if blood pressure remains elevated, you can add a vasodilator such as nitroprusside or nicardipine to achieve a target SBP around 100–120 mmHg, but only after the heart rate is controlled to avoid reflex tachycardia that could worsen the tear.

Alongside this stabilization, arrange urgent vascular surgery consultation and obtain definitive imaging (eg, CT angiography) to determine whether the dissection is type A (involving the ascending aorta) or type B (distal). Type A generally requires prompt surgical repair, whereas type B is often managed medically unless complications arise. Pain control and monitoring are important, and anticoagulants or thrombolytics and emergent PCI are not appropriate initial steps in suspected dissection, as they can worsen the dissection or cause catastrophic bleeding.

So, the best initial management is IV beta-blocker to reduce shear stress with urgent vascular surgery consultation for definitive management.