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Acute type A aortic dissection — SCE Acute Medicine MCQ

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HardCardiovascular medicineAcute type A aortic dissectionSCE Acute Medicine

A 56-year-old man presents with abrupt tearing chest pain radiating to the back. Blood pressure is 190/104 mmHg in the right arm and 156/88 mmHg in the left; he has a new early diastolic murmur and widened mediastinum on chest radiograph. Troponin is mildly raised and ECG shows nonspecific ST-T changes. What is the most appropriate investigation?

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

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Correct answer: A — Urgent CT aortography

The pain description, inter-arm blood pressure difference, aortic regurgitation murmur and widened mediastinum suggest acute aortic dissection, for which urgent CT aortography is the diagnostic test in a stable patient. Mild troponin elevation can occur and should not divert the pathway to routine ACS management. Thrombolysis or antithrombotics before excluding dissection may be catastrophic.

Reference: NICE CKS chest pain; ESC aortic diseases guidance