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Aortic dissection — MCCQE Part 1 MCQ

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ModerateChest PainAortic dissectionMCCQE Part 1

66-year-old man with long-standing hypertension presents with abrupt tearing chest pain radiating to the back. There is a 25 mmHg systolic BP difference between arms and a new early diastolic murmur. Which of the following is the most appropriate next step?

Educational content. Not a substitute for clinical judgement or local policy.

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Correct answer: C — Control pain and blood pressure, obtain urgent CT angiography and involve cardiovascular surgery

Control pain and blood pressure, obtain urgent CT angiography and involve cardiovascular surgery is best because abrupt tearing pain with pulse/BP asymmetry and aortic regurgitation suggests acute aortic syndrome. Discharge after a single normal initial test is suboptimal because early cardiac disease can be missed by one isolated result; Arrange routine cardiology review without acute risk stratification is suboptimal because routine referral is too slow for a potentially unstable presentation; Give reassurance because the patient is young or previously well is suboptimal because age alone does not exclude serious cardiovascular disease; Treat only the symptom and omit ECG or biomarker-based assessment is suboptimal because cardiac presentations require objective assessment when suggested clinically. Do not anticoagulate presumed ACS until dissection is considered in a compatible presentation.

Reference: CCS aortic disease guideline 2023