Acute Caremiddle twist
A 62-year-old man with treated hypertension develops severe pain between his shoulder blades while carrying a bag of potting mix. It was as bad in the first few seconds as it ever became, and has since moved into his lower back. He has not vomited, and the pain is no different sitting forward or lying flat. Pulse 92/min, oxygen saturation 98% on room air. Blood pressure is 172/96 mmHg in the right arm and 138/80 mmHg in the left. There is a soft early diastolic murmur at the left sternal edge and no ST-segment change on the electrocardiogram. Which one of the following is the most likely explanation for his pain?