Medicine – MCQ 152 – 50 year old smoker with breathlessness for 3 hours

A 50 year old man, an alcoholic and a smoker presents with a 3 hour history of increasing shortness of breath. He started having this pain while eating, which was constant and radiated to the back and interscapular region. He was a known hypertensive. On examination, he was cold and clammy with a heart rate of 130/min, and a BP of 80/40 mm Hg. JVP was normal. All peripheral pulses were present and equal. Breath sounds were decreased at the left lung base and chest x-ray showed left pleural effusion. Which one of the following is the most likely diagnosis?
A. Acute aortic dissection
B. Acute myocardial infarction
C. Rupture of the esophagus
D. Acute pulmonary embolism

Correct answer : A. Acute aortic dissection

Chest pain radiating to interscapular area and signs of shock indicates the diagnosis of acute aortic dissection especially in those with risk factors like hypertension.