The pain almost always radiates to the back, or may be felt only in the back, between the shoulder blades. As the dissection affects the roots of the subclavian and carotid arteries, pulse deficits, neurological signs, or a blood pressure difference between the arms may develop. Most patients will have 20 mm Hg blood pressure difference between the arms. Over half will have an aortic regurgitation murmur. About a third will have neurologic compromise.
Myocardial infarction can occur during dissection as the roots of the coronary arteries are damaged.
About 90 percent of patients will have an abnormal ECG, although it will usually not be diagnostic of a localized infarction. The chest x-ray may show an ascending aorta that extends beyond the rim of calcification, or may show a widened mediastinum. Aortography will demonstrate the dissection. Back to Index. The pain of pulmonary embolism is usually pleuritic with smaller peripheral emboli, or generalized and substernal with a large central embolism.