Clinical Presentation & Protocol
Patient Usually Complains Of
Patient presents with sudden onset of severe, tearing chest pain radiating to the interscapular region/back. Associated symptoms include hypertension, diaphoresis, and nausea. Denies syncope, focal neurological deficits, or signs of malperfusion (abdominal pain, limb ischemia). History significant for uncontrolled hypertension.
Clinical Examination Findings
Patient appears in acute distress. Vitals: BP asymmetric between arms (if applicable), tachycardia. Cardiovascular: Regular rhythm, no murmurs. Pulmonary: Clear to auscultation. Abdominal: Soft, non-tender, no pulsatile mass. Neurological: Alert and oriented, no focal deficits. Peripheral pulses: Symmetric, 2+ throughout.
Treatment Protocol
Immediate initiation of aggressive anti-impulse therapy. Goal: SBP 100-120 mmHg and HR < 60 bpm. IV beta-blockers (e.g., Esmolol/Labetalol) as first-line, followed by vasodilators (e.g., Nitroprusside) only after adequate beta-blockade. Strict bed rest, continuous hemodynamic monitoring, and serial neurological exams. Surgical/Endovascular consultation (TEVAR) initiated.