Which life-threatening condition is most likely responsible for the following presentation in the emergency department: a 58-year-old man with abrupt onset of severe, "tearing" chest pain that radiates between the shoulder blades, blood pressure 190/110 mm Hg, and a weaker left-arm pulse compared with the right?
The sudden onset of maximal, tearing chest pain radiating to the back, particularly when accompanied by hypertension and a pulse or blood-pressure discrepancy between the upper extremities, is classic for acute aortic dissection. Pericarditis causes sharp, pleuritic pain that improves when the patient leans forward and is not associated with pulse deficits. Pulmonary embolism typically presents with pleuritic chest pain and dyspnea rather than tearing interscapular pain or asymmetric pulses. Tension pneumothorax produces unilateral decreased breath sounds, tracheal deviation, and severe respiratory distress, not the findings described.
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Cardiovascular Emergencies
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