Aortic dissection Quiz: Ace Your Exams

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A 68-year-old man is brought to the emergency department for severe tearing chest pain radiating to his back for the past 2 hours and syncope. Past medical history is significant for uncontrolled hypertension. Temperature is 37.1°C (98.8°F), blood pressure is 93/52 mmHg, pulse is 120/min, respirations 18/min, and oxygen saturation is 94% on room air. Physical examination reveals weak peripheral pulses, and a 4/6 early diastolic decrescendo murmur best heard over the left lower sternal border. ECG is significant for sinus tachycardia. IV access is obtained, and intravenous fluids are administered. Which of the following is the best next step in management?  

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