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A 63-year-old man with a history of high blood pressure presents in A&E with sudden-onset tearing chest pain radiating to the back.

H Pain can also radiate down the arms and into the neck and can be difficult to distinguish from an acute myocardial infarction. Indeed these symptoms are often associated with anterior arch or aortic root dissection. The dissection can interrupt flow to the coronary arteries, resulting in myocardial ischaemia. The Stanford classification divides dissections into two types: A and B. Type A involves the ascending aorta but type B does not. This system also helps delineate treatment. Usually, type A dissections require surgery, whereas most type B dissections are usually best managed medically by aggressive reduction of blood pressure.