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Acute aortic dissection — RCPSC EM MCQ

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EasyCardiovascular emergenciesAcute aortic dissectionRCPSC EM

A 57-year-old man presents with tearing interscapular chest pain, syncope and left arm weakness. Blood pressure is 196/104 mmHg in the right arm and 156/90 mmHg in the left. ECG shows no STEMI; creatinine is 110 µmol/L and chest radiograph shows mediastinal widening. What is the most likely diagnosis?

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Correct answer: A — Acute aortic dissection

Sudden tearing pain, pulse or blood pressure differential, neurological deficit and widened mediastinum strongly suggest acute aortic dissection. Initial care includes anti-impulse therapy and urgent CT angiography or surgical pathway depending on stability.

Reference: Canadian Cardiovascular Society aortic disease guidance; Rosen's Emergency Medicine