A 22-year-old male presents to you with a chief complaint of chest pain. During your history and physical you review the aortic dissection bundle questions to which you gather a single "yes" answer. What is the appropriate next step in determining your diagnosis?

Question

Quizplus · Accepted Answer

When reviewing the aortic dissection bundle questions, a single "yes" answer indicates that dissection may be the cause of the patient's chest pain, and the diagnosis should be excluded by an emergent CT scan, MRI, or trans-esophageal echocardiogram. Thus, B is the correct answer. In the event of an TAAD, an EKG may show normal or nonspecific changes such as left ventricular hypertrophy. It may be helpful to compare EKG findings to previous baseline studies, but it is not an acceptable method to exclude TAAD from the differential diagnosis. In a patient presenting with chest pain and a positive answer to the aortic dissection bundle questions, it is inappropriate to wait a few days before evaluating via MRI (or any imaging technique) for TAAD due to the severity of the potential consequences. While an echocardiogram could be used to detect TAAD, it must be a trans-esophageal echocardiogram, not a trans-thoracic echo.

A 22-Year-Old Male Presents to You with a Chief Complaint