Patients with type B dissections or chronic dissections without evidence of complications should be weaned gradually towards oral antihypertensive therapy; a combination of a b-blocker and a vasodilator such as nifedipine is appropriate. All patients (whether hypertensive or not) should receive b-adrenergic antagonists unless there are contraindications, in which case a calcium-channel antagonist such as diltiazem should be considered. The aim is to establish the patient on therapy with a low-normal resting blood pressure without postural symptoms or evidence of organ hypoperfusion. During the initial phases of medical treatment and during weaning the patient should be observed closely for evidence of developing complications.
Those in whom initial medical management is successful should be followed closely as many will require surgery in the ensuing months or years. Some will develop extension of the original dissection, while others may develop aneurysms of the thin-walled false channel which may rupture subsequently if the aorta is not repaired. Patients with chronic dissections have survived the period of greatest danger and surgery should be withheld unless complications develop.
Was this article helpful?
Your heart pumps blood throughout your body using a network of tubing called arteries and capillaries which return the blood back to your heart via your veins. Blood pressure is the force of the blood pushing against the walls of your arteries as your heart beats.Learn more...