19th February 2025

A 68-year-old gentleman with a background of poorly controlled hypertension presents to the emergency department with a two-hour history of central tearing chest pain radiating to his back and significant progressive shortness of breath.

A 68-year-old gentleman with a background of poorly controlled hypertension presents to the emergency department with a two-hour history of central tearing chest pain radiating to his back and significant progressive shortness of breath. His observations on arrival show a blood pressure of 178/101, heart rate of 103, saturations of 89% on room air and a respiratory rate of 24. On examination, there are fine bibasal inspiratory crackles, a regular pulse and non-displaced apex beat with a new early diastolic murmur. You suspect this patient has pulmonary oedema. Given the likely diagnosis, what is the most likely aetiology of their pulmonary oedema?

Select the SINGLE most appropriate option from the list below. Select ONE option only.