History

Was the pain instantaneous in onset (like a hammer-blow or a light turning on)?

Did the pain radiate along the course of the aorta or its major branches?

Were there associated neurological symptoms (e.g. transient blurring of vision) (in 15–40% cases)?

Was there syncope (in 15% dissections)?

Is the patient at increased risk of dissection because of:

• A congenital predisposition (Marfan, Ehlers-Danlos, Turner or Loeys-Dietz syndromes or to a lesser degree a bicuspid aortic valve)
• Pregnancy
• Dilated aorta
• Family history of dissection or sudden premature death?
• Recent cardiac surgery or cardiac catheterization?

Examination

Blood pressure in both arms (the normal difference in systolic pressure is <20 mmHg).

Elevation of the JVP and arterial paradox as signs of tamponade.

Presence and symmetry of the peripheral pulses.

Early diastolic murmur of aortic regurgitation (due to distortion or dilatation of the aortic root).

Limb power and tendon reflexes.

Evidence of Marfan syndrome or other collagen abnormality.