[Acute aortic syndrome: medical care at acute phase and long-term follow-up]

Abstract

For the management of acute aortic syndromes, there is a major interest of a multidisciplinary decision: resuscitator, cardiologist, radiologist, vascular surgeons. Do not delay the thoracic computed tomography: the gold standard in such an urgent situation. Use intravenous beta-blocade therapy anytime it is possible. At the acute phase: systolic blood pressure target is < 120 mmHg, and the heart rhythm target is < 60 bpm. Type A acute aortic dissection is a surgical emergency. Type B acute aortic dissection is a medical emergency and need a management of peripheral ischemia and/or organ failures if necessary. Beta-blocade therapy has to be pursued indefinitely at discharge. The angiotensin II receptor blockers (ARB) could be a future treatment in patient swith a Marfan syndrome. All etiological investigations of hypertension are systematically performed. Cardiovascular risk stratification and management is mandatory. Educational support and use of ambulatory blood pressure monitoring. Clinical and MRI follow-up at six month and then once a year, and in any case of suspicious clinical manifestations are needed.