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Aortic dissection — RCPSC IM MCQ

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HardCardiologyAortic dissectionRCPSC IM

A 59-year-old man with longstanding hypertension develops abrupt tearing chest pain radiating to the back. Blood pressure is 196/104 mm Hg in the right arm and 164/92 mm Hg in the left, pulse is reduced in the left radial artery, and chest radiograph shows mediastinal widening. Troponin is mildly elevated. What is the most likely diagnosis?

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Correct answer: E — Acute aortic dissection

Abrupt tearing pain, pulse and blood pressure differential and mediastinal widening indicate acute aortic dissection. Troponin can be mildly elevated and should not distract from the vascular emergency.

Reference: Canadian Cardiovascular Society aortic disease update; ACC/AHA aortic disease guideline