Question:medium
A 45 year old patient with hypertension presenting with acute severe chest pain & there is diaphoresis. Also there is h/o loss of consciousness, unequal pulses. In emergency condition which is the best one to make a diagnosis
A 45 year old patient with hypertension presenting with acute severe chest pain & there is diaphoresis. Also there is h/o loss of consciousness, unequal pulses. In emergency condition which is the best one to make a diagnosis
Show Hint
Unequal pulses in a hypertensive patient with acute chest pain should point you away from ACS towards aortic pathology.
Updated On: Jun 23, 2026
- Cardiac enzymes
- MRI
- X-ray
- TEE
Show Solution
The Correct Option is D
Solution and Explanation
Clinical Diagnosis: The triad of hypertension + severe chest pain + unequal pulses in an emergency setting is classic for aortic dissection.
Investigation of choice in emergency = TEE (Transesophageal Echocardiography)
Why TEE?
Why not the others?
\[\boxed{\text{Answer: TEE}}\]
Investigation of choice in emergency = TEE (Transesophageal Echocardiography)
Why TEE?
- Bedside availability -- no need to transport an unstable patient
- No radiation, no contrast required
- Directly visualises the intimal flap and false lumen in real time
- Sensitivity $>95\%$ and specificity $>95\%$ for proximal (Type A) aortic dissection
- Can simultaneously assess aortic regurgitation and pericardial effusion (complications of dissection)
Why not the others?
- Cardiac enzymes: diagnose MI, not dissection
- MRI: best overall accuracy but takes 30-60 min -- not feasible in unstable patients
- X-ray: insensitive; widened mediastinum is only a screening clue
\[\boxed{\text{Answer: TEE}}\]
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