A 63yo BM presents with sudden onset excruciating tearing chest pain and shortness of breath. He has never had this before. His past medical history is only significant for hypertension. Lungs are clear and heart is regular with a blowing diastolic murmur upon auscultation. Abdomen is soft without pulsatile mass.
Pulses are equal in the extremities.
No neurological abnormalities are noted. EKG reveals an inferior infarction pattern. The patient was placed on intravenous nitrate therapy and given aspirin. He was emergently taken for cardiac catheterization to rule out the possibility of aortic dissection, as well as address the ongoing infarction. The catheterization revealed a Type A, or Type I aortic dissection and the patient was redirected to the operating room where he underwent successful repair.