Lower wall tension by lowering BP (La Place T = P × r)
Important considerations
Right radial arterial line or right arm blood pressure will be the most accurate
Beta blockers are good first-line options, since they reduce heart rate and<unk>  wall tension
However, avoid β-blockers in<unk>  regurgitation murmurs or on bedside echo
It is important to provide adequate analgesia in order to decrease sympathetic output leading to tachycardia and hypertension
Right radial arterial line or right arm blood pressure will be the most accurate
Beta blockers are good first-line options, since they reduce heart rate and<unk>  wall tension
However, avoid β-blockers in<unk>  regurgitation murmurs or on bedside echo
It is important to provide adequate analgesia in order to decrease sympathetic output leading to tachycardia and hypertension
However, avoid β-blockers in<unk>  regurgitation murmurs or on bedside echo
Advantage of short half life, easily titratable
Bolus 0.5mg/kg over 1min; infuse 0.05mg/kg/min (titrate upward in 0.05mg/kg/min increments to a maximum of 0.3 mg/kg/min)
Esmolol Drip Sheet
Push dose - 10-20mg with repeat doses of 20-40mg q10min up to 300mg
Drip - Load 15-20mg IV, followed by 5mg/hr
5mg IV x 3; infuse at 2-5mg/hr
Loading 0.25mg/kg over 2–5 min, followed by a drip of 5mg/h
Do not control blood pressure without adequate heart rate control (must suppress reflex tachycardia which will shear forces from increased HR)
5mg/hr start, then titrate up by 2.5mg/hr every 10 min until goal
Once at goal, drop to 3mg/hr and re-titrate from there
May initially bolus 2mg IV
Morphine/Fentanyl - Decreases sympathetic output
Type A (any portion of ascending aorta)
Requires surgery
Type B (isolated to descending aorta)
Primarily medical management with surgery consultation
Requires surgery
Primarily medical management with surgery consultation
Nontraumatic thoracic aortic dissection
Acute coronary syndromes 
Coronary artery dissection
STEMI
Left ventricular aneurysm
Non-STEMI
Left ventricular pseudoaneurysm
Unstable angina