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Aortic dissection — ACEM Fellowship MCQ

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HardCardiovascular emergenciesAortic dissectionACEM Fellowship

A 56-year-old woman presents to an Auckland ED, triage category 2, with sudden tearing chest pain radiating to the back. BP is 198/104 in the right arm and 164/90 in the left, HR 102. She has a new early diastolic murmur and transient left arm weakness. ECG shows nonspecific ST-T changes and troponin is normal. What is the most appropriate investigation?

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

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Correct answer: B — CT aortogram from arch to femoral vessels

Abrupt tearing pain, pulse or BP differential, neurological symptoms and aortic regurgitation signs make dissection likely; CT aortography defines extent and branch involvement.

Reference: ACEM FACEM Curriculum; eTG acute aortic syndrome guidance