C  

Initial therapy for acute aortic dissection is “anti-impulse” control with intravenous β-blockers (e.g., esmolol or labetalol) to rapidly lower heart rate (<60 bpm) and reduce shear stress before any other interventions are considered; surgery is reserved mainly for ascending (type A) dissections, and anticoagulation is contraindicated. [Mohindra, 1991, PMID 1683074; O’Gara, 1999, PMID 11096464; Kesieme, 2024, PMID 39078908]