What are classic signs of an aortic dissection?

• A. Gradual onset dull chest pain with stable blood pressure.
• B. Sudden severe chest or back pain with tearing quality; unequal blood pressures in limbs.
• C. Intermittent chest pain relieved by antacids.
• D. Chronic shortness of breath without chest pain.

Answer: (B)

Aortic dissection presents with abrupt, severe chest or back pain that often has a tearing or ripping quality and may migrate as the dissection extends. A key clue is unequal blood pressures (or pulses) between limbs because the dissection can involve branch vessels supplying the arms and legs. If the dissection reaches the aortic root, a new diastolic murmur from aortic regurgitation can occur, and neurologic symptoms may appear if the carotids are involved. These features differentiate it from other chest pain etiologies like gradual dull pain with stable blood pressure (more typical of coronary disease), intermittent pain relieved by antacids (GERD), or chronic shortness of breath without chest pain (often heart or lung diseases). In any case with sudden tearing chest/back pain and asymmetric limb pressures, treat as a medical emergency and pursue rapid imaging (often CT angiography) while reducing shear stress with appropriate heart rate and blood pressure control.