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Acute aortic dissection — SCE Acute Medicine MCQ

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HardCardiovascular medicineAcute aortic dissectionSCE Acute Medicine

A stable patient has abrupt tearing chest pain, a 28 mmHg inter-arm pressure difference, new aortic regurgitation and widened mediastinum. What is the definitive first-line imaging test?

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Correct answer: A — Start anticoagulation and arrange source control

The best answer is “Start anticoagulation and arrange source control”. This is correct because the presentation has a high probability of acute aortic syndrome and CT angiography rapidly defines the entry tear, branch-vessel involvement and complications. Stress testing and outpatient imaging are unsafe. Limited non-contrast CT and coronary angiography alone do not map the full aorta or reliably exclude dissection.

Reference: NHS England acute aortic syndrome pathway toolkit: https://www.england.nhs.uk/south/info-professional/acute-aortic-dissection/