Question

A 72-year-old with sudden tearing chest pain radiating to the back has BP 190/110 mm Hg, HR 110, unequal arm pressures. CXR shows widened mediastinum. First-line immediate pharmacologic step?

Accepted Answer

IV esmolol to reduce shear stress before vasodilators

Answer

IV nitroprusside alone to reduce BP

Answer

High-dose morphine only

Answer

Start heparin infusion

Answer

Avoid BP lowering until imaging confirms diagnosis

Practice question

A 72-year-old with sudden tearing chest pain radiating to the back has BP 190/110 mm Hg, HR 110, unequal arm pressures. CXR shows widened mediastinum. First-line immediate pharmacologic step?