A 32-year-old athlete presents with severe interscapular pain after training....

Clinical scenario
A 32-year-old athlete presents with severe interscapular pain after training. He is of slim build and tall (210 cm). He has a sinus tachycardia and his BP is 180/100 mmHg with no deficit between his right and left arm. There are no murmurs and all his peripheral pulses are palpable.
The rest of his physical examination is normal.
A CXR shows widened mediastinum and a CT confirms an aortic dissection distal to the left subclavian artery that does not involve the aortic arch.

Question
Which of the following is the most appropriate intervention?
A Intravenous calcium antagonist
B Intravenous labetalol
C Urgent cardiothoracic surgical referral
D Transoesophageal echocardiography
E Oral angiotensin-converting enzyme inhibitor

Answer:
B Intravenous labetalol

Discussion: This man has a type B dissection and so the main treatment is to
control the BP. A beta-blocker would be the first-choice agent as this reduces the shear wall stress of
the aorta.

Cardiothoracic referral is indicated in type A dissection, and in type B dissection if there is evidence
of ongoing dissection with organ or limb ischaemia.