NBME Step 2 CK Form 8 Thoracoabdominal aortic dissection (NBME Answers)

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submitted by ∗step_prep(148)

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Middle-aged man with tearing back pain unresponsive to nitroglycerin but responsive to morphine and labetalol found to have severe upper extremity blood pressure with diminished lower extremity pulses, most consistent with an aortic dissection
Key idea: Aortic dissection can spread to involve the coronary arteries, leading to an MI (i.e. just because a patient has chest pain and ECG changes consistent with an MI does NOT exclude aortic dissection as a diagnosis)
Key idea: Beta-blockers are particularly useful in setting of aortic dissection because the force of blood being ejected from the LV and hitting the aorta can further propagate the tear, with beta blockers leading to reduced contractility and reduced force of blood ejection against the aorta

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cbreland I thought that the unequal pulses were in the arms. Is it different because of the dissection being more in the abdomen? +1