Aortic dissection Quiz: Ace Your Exams

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A 61-year-old man presents to the emergency department for evaluation of sudden onset severe, sharp, chest pain that radiates to the back and dyspnea. Past medical history is significant for hypertension and a 30-pack-year smoking history. Temperature is 37.2°C (°F), blood pressure is 195/140 mmHg in his right arm and 161/105 mmHg the left arm, pulse is 115/min, respirations 20/min, and oxygen saturation is 92% on room air. On physical examination, the patient appears uncomfortable. Pulmonary examination is significant for bilateral basilar rates. Which of the following murmurs is mostly likely to be heard on cardiac auscultation?

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Holosystolic ejection murmur best heard at the apex

Mid-diastolic rumbling murmur with an opening snap

Early diastolic decrescendo murmur best heard at the left lower sternal border

Continuous murmur over the back between the scapula along with decreased lower extremity pulses

A crescendo-decrescendo systolic murmur best heard at the 2nd right intercostal space