A 70-year-old man with hypeension wakes up with severe chest pain and diaphoresis. On examination he has bounding pulses with wide pulse pressure. A diastolic murmur is heard along the right sternal border. Which of the following is the possible etiology?
**Core Concept**
The patient's presentation of severe chest pain, diaphoresis, bounding pulses with wide pulse pressure, and a diastolic murmur along the right sternal border is suggestive of aortic dissection. This condition involves a tear in the intimal layer of the aorta, leading to separation of the aortic wall layers and potential compromise of aortic branches.
**Why the Correct Answer is Right**
Aortic dissection is characterized by the presence of a diastolic murmur due to the disruption of blood flow across the aortic valve, resulting in aortic regurgitation. The wide pulse pressure and bounding pulses are also consistent with this diagnosis, as the aortic valve is unable to close properly, leading to a decrease in diastolic blood pressure. The patient's severe chest pain and diaphoresis are also typical symptoms of aortic dissection. The aortic dissection can be further confirmed by imaging studies such as CT angiography.
**Why Each Wrong Option is Incorrect**
**Option B:** STEMI with papillary muscle dysfunction typically presents with acute mitral regurgitation, which would be a systolic murmur, not a diastolic murmur.
**Option C:** Myocarditis with functional regurgitation would also present with a systolic murmur, not a diastolic murmur, and would not typically cause bounding pulses with wide pulse pressure.
**Option D:** Flash pulmonary edema is a condition characterized by rapid onset of pulmonary edema, often due to acute left ventricular failure. It would not typically present with a diastolic murmur or bounding pulses with wide pulse pressure.
**Clinical Pearl / High-Yield Fact**
Aortic dissection is a medical emergency that requires immediate attention. The "3 Ps" of aortic dissection are pain, pulse deficit, and a palpable thrill or murmur. Remember to suspect aortic dissection in patients with severe chest pain and a diastolic murmur.
✓ Correct Answer: A. Aortic dissection.