Intravenous esmolol in acute aortic dissection

• Published in: DICP (Cincinnati, Ohio) Vol. 25; no. 7-8; p. 735
• Main Authors: Mohindra, S K, Udeani, G O
• Format: Journal Article
• Language: English
• Published: United States 01.07.1991
• Subjects: Acute Disease; Adrenergic beta-Antagonists - therapeutic use; Aged; Aneurysm, Dissecting - drug therapy; Aneurysm, Dissecting - physiopathology; Aortic Aneurysm - drug therapy; Aortic Aneurysm - physiopathology; Blood Pressure - drug effects; Female; Heart Rate - drug effects; Humans; Nitroprusside - therapeutic use; Propanolamines - therapeutic use
• DOI: 10.1177/106002809102500706
• ISSN: 1042-9611

Acute aortic dissection is a devastating condition requiring prompt intensive pharmacologic management geared toward control of blood pressure and reduction in myocardial contractility (change in velocity/change in time). The treatment of choice currently is sodium nitroprusside and intravenous propranolol hydrochloride. During acute aortic dissection, hemorrhage may spread into the interatrial septum, extending to the atrioventricular junctional tissues, thus causing conduction abnormalities. Adverse effects of long-acting beta-blockers, including bradycardia, heart failure, and bronchospasm, may limit their usefulness because these effects persist for a long time after discontinuation. This may be detrimental, especially in patients with compromised cardiac function, bronchospastic disease, or both. We report a case of a 64-year-old woman with compromised cardiac function and aortic dissection who was successfully treated with esmolol hydrochloride (an ultrashort-acting beta-blocker) and sodium nitroprusside.