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Acute aortic dissection — RCPSC EM MCQ

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HardCardiovascular emergenciesAcute aortic dissectionRCPSC EM

A 61-year-old man develops abrupt tearing chest pain radiating to the back. Blood pressure is 202/108 mmHg in the right arm and 176/92 mmHg in the left; pulse is reduced in the left radial artery. Chest radiograph shows a widened mediastinum and creatinine is normal. What is the most appropriate investigation?

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Correct answer: A — CT angiography of the aorta

The presentation is high-risk for acute aortic dissection. CT angiography is the usual rapid diagnostic test in a stable patient with adequate renal function; blood pressure control should proceed in parallel.

Reference: Canadian Cardiovascular Society aortic disease guidance; emergency medicine consensus