In acute aortic dissection, which short-acting beta-blocker is preferred for rapid HR control?

• A. Propranolol
• B. Esmolol
• C. Atenolol
• D. Carvedilol

Answer: (B)

Rapid control of heart rate is essential in acute aortic dissection to lower shear stress on the aortic wall. A short-acting IV beta-blocker is ideal because it lets you titrate the dose precisely and quickly adjust or stop the effect if the patient becomes hypotensive or bradycardic.

Esmolol fits best because it is ultra-short-acting and given IV, with onset in minutes and a half-life of about nine minutes. This allows rapid reduction of heart rate and easy discontinuation if needed, which is crucial in the unstable, early phase of dissection management.

Other beta-blockers either act too slowly or have longer, less controllable effects. Propranolol and atenolol have longer durations and slower onsets, making rapid titration risky in an emergent setting. Carvedilol also has a longer, non-ideal duration and additional alpha-blocking effects that aren’t advantageous for quick HR control in this scenario.

So, the best choice for rapid HR control in acute aortic dissection is the short-acting IV beta-blocker that can be titrated and stopped promptly, esmolol.