ZyraDoc #17 - August 18, 2026

A 58-year-old man with poorly controlled hypertension presents to the emergency department with sudden-onset, excruciating, tearing chest pain radiating to his back between the scapulae.

His initial blood pressure is 198/110 mmHg, pulse is 108 bpm, and physical examination demonstrates an asymmetrical pulse deficit in the left radial artery and a new early diastolic murmur.

The triage team prepares to immediately administer IV thrombolytic therapy (Alteplase) under the assumption of an acute inferior myocardial infarction.

Case Summary

Clinical Focus:

A 58-year-old hypertensive male presents with acute, severe tearing chest pain radiating to the back and inter-arm pulse asymmetry, characteristic of Stanford Type A acute aortic dissection.

Diagnostic Features of Acute Aortic Dissection:

Sudden-onset, severe, tearing or ripping chest/back pain with maximal intensity at onset
Pulse deficits or significant blood pressure differential (> 20 mmHg systolic) between upper extremities
New aortic regurgitation murmur, neurological deficits, or widened mediastinum on chest radiograph

Immediate anti-impulse therapy (rate control followed by blood pressure reduction) combined with emergency cardiothoracic surgical consultation is vital to prevent fatal rupture.

Here is the Management Strategy:

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