What condition would you most likely suspect?

You are treating a 49-year-old patient who complains of an intense pain between his shoulder blades radiating to his lower back. Pain began 10 minutes prior to your arrival while he was eating and has been constant. He rates the pain as a 10 out of 10. Pain is described as a sharp, tearing pain. He has no significant past medical history. Blood pressure is 130/76 mm Hg in the right arm and 78/48 mm Hg in the left arm, radial pulse in his right arm is 98 beats per minute and regular, and respiratory rate is 20 per minute and non-labored.

What condition would you most likely suspect?
A . Myocardial infarction
B . Angina pectoris
C . Aortic dissection
D . Congestive heart failure

Answer: B

Explanation:

Differing blood pressures in each arm, as well as the description of a sharp, tearing pain between the shoulder blades, may indicate an aortic dissection. This is a definite medical emergency that warrants immediate transport to the emergency department.