Patient with atypical chest pain? Is it abrupt-onset and ripping, tearing, or stabbing in nature? Then:
- check pulse and BP in both arms
- be alert for signs of shock
- look for focal neurological symptoms/signs
- look for limb ischaemia
- when listening for heart sounds, check for an aortic regurgitation murmur
because it could be aortic dissection. Predisposing factors include Marfan’s syndrome, a known thoracic aortic aneurysm, and recent aortic manipulation.