MRCP2-0417

MRCP2-0417

A 56-year-old man with a history of hypertension and smoking presents to the Emergency Department with central chest pain radiating to his back for the past two hours. He is hypotensive with a bp of 80/60 mmHg and a pulse of 105 bpm. Bilateral basal crackles are heard on chest auscultation. An ECG shows evidence of inferior ST elevation. A transoesophageal ECHO reveals a double lumen in the ascending aorta. What is the most likely diagnosis based on this clinical presentation?