Question 1

Q: A 62-year-old hypertensive male presents to the emergency department with sudden-onset tearing chest pain radiating to the back. BP is 180/110 mmHg in the right arm and 150/90 mmHg in the left arm. ECG shows no ST changes. The patient is hemodynamically stable. The chest X-ray is shown in Image 2. What is the most appropriate immediate next investigation?

A. CT aortography with intravenous contrast. ***A. CT aortography with intravenous contrast*** - In a **hemodynamically stable** patient with tearing chest pain, blood pressure disparity, and **mediastinal widening**, CT aortography is the gold standard for rapid confirmation. - It accurately identifies the **intimal flap**, determines the **Stanford classification**, and evaluates involvement of major arterial branches for surgical planning. *B. Transthoracic echocardiography* - While useful at the bedside, it has low sensitivity for the **descending aorta** and may miss a **Stanford Type B** dissection. - It is generally reserved for **unstable patients** in the emergency room or as a supplement to identify complications like **aortic regurgitation** or **pericardial effusion**. *C. Ventilation-perfusion scintigraphy* - This investigation is used to diagnose **pulmonary embolism** and has no role in the evaluation of the **aorta**. - The clinical presentation of **tearing pain radiating to the back** and asymmetric pulses is highly specific for **aortic dissection** rather than a pulmonary cause. *D. Coronary CT angiography* - This modality is optimized for visualizing the **coronary arteries** and does not provide the comprehensive field of view required to assess the entire length of the **aorta**. - It lacks the specific **bolus timing** and scan range necessary to adequately map a **dissection flap** from the arch through the abdomen.

Question

A 62-year-old hypertensive male presents to the emergency department with sudden-onset tearing chest pain radiating to the back. BP is 180/110 mmHg in the right arm and 150/90 mmHg in the left arm. ECG shows no ST changes. The patient is hemodynamically stable. The chest X-ray is shown in Image 2. What is the most appropriate immediate next investigation?

Accepted Answer

A. CT aortography with intravenous contrast

Answer

B. Transthoracic echocardiography

Answer

C. Ventilation-perfusion scintigraphy

Answer

D. Coronary CT angiography

Cardiology — MCQs

Cardiology — MCQs

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