Acute Aortic Syndromes; Roadside to Resus

Acute aortic syndromes—comprising aortic dissection, intramural hematoma, penetrating atherosclerotic ulcer, and incomplete dissection—represent high-mortality, frequently misdiagnosed emergencies. These conditions share common pathophysiological pathways involving the breakdown of the aortic intima and media, often triggered by hypertension, physical trauma, or underlying connective tissue disorders. While symptoms like severe, acute-onset pain are common, they lack high diagnostic specificity, necessitating a high index of clinical suspicion. Definitive diagnosis requires CT angiography, as ECGs and chest radiographs often prove inconclusive. Once identified, management focuses on reducing aortic wall stress through aggressive pain control and titration of blood pressure to 100–120 mmHg systolic and heart rate below 60 beats per minute using intravenous beta-blockers. These interventions are critical to limiting dissection propagation and preventing end-organ damage while coordinating definitive surgical or endovascular repair.