10th March 2024

A 51-year-old taxi driver presents to A&E with sudden onset, central sharp chest pain.

A 51-year-old taxi driver presents to A&E with sudden onset, central sharp chest pain. His past medical history is significant for poorly controlled hypertension. On examination, his BP is 210/120 mmHg on the left arm, 185/120 mmHg on the right arm, heart rate 103 bpm, temperature 37.1C, respiratory rate 19 breaths per minute and oxygen saturations of 95% on room air. He appears pale and clammy and has a new diastolic murmur at the left sternal edge. He is given a stat dose of 5mg amlodipine with no significant effect on blood pressure. What is the most likely diagnosis? 

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