Sudden collapse with chest pain and shock

Author: Jason M Kendall / Editor: Jason M Kendall / Reviewer: Michael Perry, Muhammad Waseem / Codes: R2 / Published: 04/12/2022

A 67-year-old man is brought into the emergency department (ED) with collapse associated with chest pain.

He has a history of hypertension and has had a previous myocardial infarction. He takes ramipril, atenolol, aspirin and simvastatin.

On examination he is in marked pain, and is pale and clammy. His observations are as follows: P = 105, BP = 90/50, SaO2 = 92% on 15 litres O2, RR = 25, Temperature = 35.8 degrees centigrade. His JVP is elevated. His heart sounds are quiet and there is a diastolic murmur. Chest auscultation reveals some bilateral basal crackles.

His ECG shows a sinus tachycardia with minimal inferior ST segment depression.

His CXR is as shown:

CXR thoracic dissection.preview

You suspect that this patient is suffering from an acute aortic dissection.


  1. Nadia Zahoor says:

    Increased knowledge about investigation of choice in aortic dissection

  2. Ume Hani Binte Yousuf says:

    Very helpful and informative

  3. Faiza Rizwana says:

    It is helpful and knowledgeable

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