AORTIC DISSECTION DUE TO DISCONTINUATION OF BETA-BLOCKER THERAPY

Beta-Blockers are known to protect a vulnerable aorta from acute disse ction, as well as reducing the risk of recurrent dissection. This case presentation reports the history of a 60-year-old male suffering from acute aortic dissection following discontinuation of beta-blocker the rapy. The patient has shown arterial hypertension for about 20 years t reated solely by beta-blockers. Two days after stopping the use of met oprolol, a nonselective beta1-blocker without ISA, the patient develop ed severe chest pain during exercise. Diagnosis of type I-aortic disse ction according to DeBakey was achieved by transthoracal echocardiogra phy and computed tomography. Successful surgery by replacement of the ascending aorta was performed about 1 h following admission to the int ensive care unit. During the procedure, tamponade of the left ventricl e occurred followed by cardiogenic shock. Postoperative management was complicated by prolonged respiratory therapy and acute gastrointestin al bleeding; 1-year follow-up showed no evidence of disease. Thus, in this case acute dissection may be the consequence of discontinuing the use of metoprolol, possibly due to uncontrolled hypertension or speci fic response to the beta-blocker.