61
Table 25. Aorta Simplified Score (AORTAs) Pretest
Probability Assessment Score
Clinical Item Points
Hypotension/shock 2
Aneurysm 1
Pulse deficit 1
Neurologic deficit 1
Severe pain 1
Sudden-onset pain 1
e patient is given the number of points corresponding to each clinical item that is positive
in the patient's presentation. e points are summed, and a total score of 0 to 1 point is low-
probability of aortic dissection, where a total of ≥2 points is high probability.
Used with permission from Morello, et al. J Am Heart Assoc. 2021;10:e018425.
7.3.1. Acute Medical Management of AAS
COR LOE
Recommendations
1 B-NR 1. In patients presenting to the hospital with AAS, prompt
treatment with anti-impulse therapy with invasive monitoring
of BP with an arterial line in an ICU setting is recommended as
initial treatment to decrease aortic wall stress.
1 C-LD 2. Patients with AAS should be treated to an SBP <120 mm Hg
or to lowest BP that maintains adequate end-organ perfusion, as
well as to a target heart rate of 60 to 80 bpm.
1 B-NR 3. In patients with AAS, initial management should
include intravenous beta blockers, except in patients with
contraindications.
2a B-NR In those with contraindications or intolerance to beta blockers,
initial management with an intravenous non-dihydropyridine
calcium channel blocker is reasonable for heart rate control.
1 C-LD 4. In patients with AAS, initial management should include
intravenous vasodilators if the BP is not well controlled after
initiation of intravenous beta-blocker therapy.
1 C-EO 5. Patients with AAS should be treated with pain control, as
needed, to help with hemodynamic management.
