30th April 2024

A 55-year-old woman presents to the emergency department with sudden onset severe chest pain radiating to her back.

A 55-year-old woman presents to the emergency department with sudden onset severe chest pain radiating to her back. The pain is described as tearing in nature and began while she was gardening. Her past medical history includes hypertension and hyperlipidemia. Her blood pressure is 145/90 mmHg, and her heart rate is 110 bpm. Physical examination reveals a diastolic murmur and decreased pulses in her left arm compared to her right arm.

Which is the most appropriate diagnostic investigation?