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A 62-year-old male presents to the ER with sudden onset of severe, tearing chest pain radiating to his back. His blood pressure is 180/110 mmHg. A bedside echo shows a pericardial effusion. What is the most appropriate next step in management?
In suspected ascending aortic dissection, strict blood rate control (e.g., labetalol) is the immediate priority to reduce aortic wall stress.
- B is incorrect: Pericardiocentesis in dissection-related tamponade can worsen bleeding.
- C is incorrect: Imaging is required, but rate control must occur first.
- D is incorrect: Heparin is contraindicated and would exacerbate bleeding.
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