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Aortic dissection — MCCQE Part 1 MCQ

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HardChest PainAortic dissectionMCCQE Part 1

A 58-year-old man with long-standing hypertension presents with sudden tearing chest pain radiating to the back. He has a right arm blood pressure of 190/98 mmHg, a left arm blood pressure of 160/84 mmHg and a new early diastolic murmur. Which of the following is the most likely diagnosis?

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Correct answer: D — Acute aortic dissection

Abrupt tearing pain radiating to the back, pulse or blood pressure differential and aortic regurgitation point to acute aortic dissection. Pericarditis usually has pleuritic positional pain and diffuse ST elevation; pulmonary embolism more often causes pleuritic dyspnoea and hypoxaemia. The teaching point is that uncontrolled hypertension plus focal vascular findings should trigger urgent CTA and surgical or vascular consultation.

Reference: Canadian Cardiovascular Society cardiovascular emergency resources; provincial emergency medicine pathways