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Acute type A aortic dissection — SCE Acute Medicine MCQ

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HardAcute Cardiac PresentationsAcute type A aortic dissectionSCE Acute Medicine

A 52-year-old man presents with abrupt tearing chest pain radiating to the back. BP is 190/105 mmHg in the right arm and 162/88 mmHg in the left, pulse is 112, and a new early diastolic murmur is heard. ECG shows no ST elevation and troponin is normal. What is the most appropriate investigation?

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Correct answer: D — Urgent CT angiography of the aorta

The abrupt pain, inter-arm BP difference and new aortic regurgitation suggest acute aortic dissection, best assessed with urgent CT aortography in a stable patient. D-dimer is not a definitive rule-out in this high-risk presentation. Coronary angiography may delay diagnosis and anticoagulation could be dangerous if ACS is assumed. The key pitfall is mistaking dissection for ACS before imaging the aorta.

Reference: NICE CKS chest pain, ESC aortic disease guideline