JBL EMT Practice Exam

A 66-year-old woman presents with a stabbing pain in the middle of her chest that radiates to her back. She tells you that the pain suddenly began about 30 minutes ago and has been severe since the onset. She has a history of hypertension but admits to being noncompliant with her antihypertensive medications. When you assess her, you find that her blood pressure is significantly higher in her left arm than it is in her right arm. What do these signs and symptoms MOST likely indicate?

1. Acute myocardial infarction

2. Dissecting aortic aneurysm

3. Hypertensive emergency

4. Unstable angina

The correct answer is: Acute myocardial infarction

The signs and symptoms described in the scenario, specifically the sudden onset of severe stabbing chest pain radiating to the back, along with a significant difference in blood pressure between the arms, are highly indicative of a dissecting aortic aneurysm. In this condition, the inner layers of the aorta tear, allowing blood to flow between the layers, creating a false lumen. This can lead to severe chest or back pain and a difference in blood pressure between the arms due to compromised blood flow. Acute myocardial infarction (Option A) typically presents with chest pain or discomfort that may radiate to the arms, neck, jaw, back, or stomach, but the description of the pain in this scenario is more consistent with aortic dissection. Hypertensive emergency (Option C) usually presents with severe hypertension and signs of end-organ damage, such as hypertensive encephalopathy or pulmonary edema, which are not described in the scenario. Unstable angina (Option D) presents with chest discomfort or pain that is new, worsening, or occurs at rest, but it is not typically associated with the significant difference in blood pressure between the arms as described in the scenario.