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Type A aortic dissection with tamponade — RCPSC EM MCQ

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HardCardiovascular emergenciesType A aortic dissection with tamponadeRCPSC EM

A 68-year-old woman presents CTAS 1 with tearing chest pain radiating to the back and syncope. BP is 88/54 in the right arm and 118/70 in the left, HR is 122, and ECG shows non-specific ST-T changes. Bedside echo shows pericardial effusion with right atrial collapse. What is the most appropriate next step?

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Correct answer: C — Call cardiac surgery and start analgesia with impulse control

The combination of tearing pain, pulse/BP differential and tamponade physiology suggests type A aortic dissection. Surgical involvement is urgent; anticoagulation or lysis may be catastrophic.

Reference: Royal College Emergency Medicine exam format and training experiences