Management of Acute Aortic Syndrome

Acute aortic syndrome (AAS) consists of a constellation of potentially life-threatening pathologies that include aortic dissection (AD), intramural hematoma (IMH), and penetrating aortic ulcer (PAU). Moderate to severe hypertension is a universal risk factor for AAS. Diagnosis of AAS requires a high index of suspicion when individuals present with acute onset retrosternal pain radiating to the back. Echocardiography provides a rapid means of assessment in the diagnosis of aortic dissection. Transthoracic echocardiography (TTE) can also provide information about structures affected by AAS. Intravenous antihypertensives are key for all patients presenting with AAS, particularly in those with aortic dissection to reduce flap mobility and propagation, which is associated with increased morbidity and mortality. The general concepts of the management of AAS include intensive monitoring and blood pressure normalization to prevent involvement of the ascending aorta or visceral vessels, as well as aortic rupture.