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Myocardial Infarction vs. Aortic Dissection: Critical Decisions in Acute Chest Pain Management and Blood Pressure Control

Two Hispanic doctors in an emergency room, analyzing medical data on a digital screen. The doctor points to the screen with a thoughtful expression, while the doctor holds a tablet and nods. The image reflects professionalism and critical decision-making in acute chest pain scenarios, including myocardial infarction and aortic dissection, emphasizing the importance of ECG and blood pressure control.

Acute chest pain is one of the most challenging symptoms in medical practice, particularly in emergency settings. Two of the most critical conditions that can present with this symptom are myocardial infarction and aortic dissection. Both require rapid and accurate diagnosis to prevent fatal consequences. In this article, we will explore the key differences between these two conditions and the critical decisions that must be made in the management of severe chest pain.

Diving into Differential Diagnosis

Myocardial infarction is characterized by the obstruction of blood flow to the heart, usually due to a thrombus in a coronary artery. Typical symptoms include oppressive chest pain that may radiate to the left arm, neck, or jaw. The use of an ECG is essential to identify a myocardial infarction, especially in cases of STEMI (ST-elevation myocardial infarction) [1].

On the other hand, aortic dissection is a vascular emergency in which a tear in the inner layer of the aorta allows blood to flow between the layers of the aortic wall, creating a false lumen. This condition presents with sudden, tearing chest pain, often described as pain radiating to the back. Identifying an aortic dissection can be more complex, as it may mimic other conditions such as myocardial infarction. An emerging biomarker, sST2, has shown promise in differentiating aortic dissection from other causes of chest pain [2].

The importance of blood pressure control is critical in both conditions. In myocardial infarction, managing blood pressure can help reduce the workload on the heart, while in aortic dissection, aggressive blood pressure control is essential to prevent the progression of the dissection [3].

Conclusions

Managing acute chest pain requires rapid and accurate evaluation to differentiate between myocardial infarction and aortic dissection. Utilizing diagnostic tools such as ECG and specific biomarkers can significantly improve diagnostic accuracy. Furthermore, blood pressure control is an essential component in the management of both conditions. Continuous education and updates in diagnostic and therapeutic practices are fundamental to improving outcomes in patients with severe chest pain.

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Created 6/1/2025