Medical management of blood pressure and heart rate in acute type b aortic dissections: a single quaternary Centre perspective
Tran, Q and Herlihy, D and Tran, V and Puttaswamy, V, Medical management of blood pressure and heart rate in acute type b aortic dissections: a single quaternary Centre perspective, pp. 22-22. ISSN 1742-6731 (2020) [Conference Extract]
Background: Analgesic and antihypertensive choice in
acute type B aortic dissection (TBAD) is still based
mainly on personal experience and expert opinion.
Objectives: This study examines a patientís course
through the emergency department (ED), and choice of
analgesia and antihypertensive agents used within an
Australian quaternary hospital.
Method: Between May 2012 and February 2019,
43 patients with acute TBAD managed through the
ED at Royal North Shore Hospital (RNSH) were retrospectively analysed via the hospital electronic
Results: For the 43 patients, 93% had an admission systolic BP over 120 mmHg (mean 160 mmHg) and 93%
had a HR over 60 bpm (mean 76 bpm). The mean time
to be seen by a MO in ED was 12.3 min with a mean
length of stay in ED 303 min. The mean time to CTa
was 4 h 17 min. 7 different types of analgesia were prescribed in ED with Morphine being the most common
(50%). 13 different types of antihypertensive agents were
prescribed in ED of which Metoprolol was most frequently used (36%), followed by Hydralazine (11%) and
Prazosin (11%). 46% of patients were prescribed 2 antihypertensive agents and 32% with 3 or more. 77% of
these patients were transferred to an ICU from
ED. Within the ICU, 12 different antihypertensive agents
were used where the agent of choice was IV Metoprolol (21%).
Conclusion: A more standardised approach to the treatment of HR and BP in acute TBAD is imperative in
ensuring optimal medical management. This is currently
being further analysed though a registry at RNSH.