Which statement best describes how esmolol works in acute dissecting aneurysm management?

• A. Calcium channel blockade
• B. ACE inhibition
• C. Beta-1 adrenergic receptor blockade leading to decreased heart rate
• D. Non-selective beta-blockade

Answer: (C)

In acute dissecting aneurysm management, the goal is to quickly lower heart rate and blood pressure to reduce the shear stress on the aortic wall. Esmolol achieves this by selectively blocking beta-1 receptors on the heart, which lowers heart rate and contractility. This decreases the rate of rise of arterial pressure (dP/dt) and the overall wall stress, helping stabilize the aorta while other antihypertensives are started. Esmolol is given IV with a rapid onset and a very short half-life, allowing tight, safe titration and easy cessation if needed. The action described is beta-1 adrenergic receptor blockade leading to decreased heart rate. It’s not calcium channel blockade, nor ACE inhibition, and it’s not non-selective beta-blockade, which would block both beta-1 and beta-2 receptors and can cause additional issues.