The Symptoms and Signs of Acute Aortic Dissection: Clinical Diagnosis of “The Great Masquerader”

There is a “classic” constellation of symptoms and signs of acute aortic dissection that is commonly taught in medical school. One classic example would be a 72 year-old man with a history of longstanding hypertension, who presents with the acute onset of severe stabbing, interscapular back pain; on arrival he is diaphoretic and restless, with a blood pressure of 195/110 mmHg. A second example would be a 35-year-old woman, who is tall and thin, presenting with the acute onset of severe tearing chest pain that radiates to her neck and then moves to her back as well; her blood pressure is 20 mmHg lower in the right arm than in the left, and on physical examination she has a loud decrescendo diastolic murmur at the left sternal border. Offered these clinical vignettes, most medical students would readily propose aortic dissection as the most likely diagnosis.