First-line pharmacologic therapy for acute aortic dissection aims to control heart rate and blood pressure; which drug is commonly used for rapid HR control?

• A. Furosemide
• B. Nifedipine
• C. Esmolol
• D. Lisinopril

Answer: (C)

Lowering heart rate quickly to reduce shear stress on the damaged aorta is the primary aim of initial therapy in acute aortic dissection. An IV beta-blocker with rapid onset and easy titration is ideal for this purpose, and esmolol fits best. Esmolol is a short-acting beta-1 selective blocker given IV, beginning to work within minutes and fading quickly when the infusion stops. This lets clinicians rapidly lower heart rate—and thus reduce the force of left-ventricular ejection against the dissection—while maintaining the ability to fine-tune the dose as the patient’s blood pressure and perfusion are managed.

Other options don’t align as well with the need for immediate heart-rate control. Furosemide reduces preload, which can help if volume overload is present but doesn’t address rapid HR control. Nifedipine lowers blood pressure through vasodilation, but it can cause reflex tachycardia, counteracting the aim of slowing the heart rate. Lisinopril provides longer-term blood-pressure reduction but has slower onset and is not appropriate for rapid HR control in the acute setting.