Divided

A 43 year old man presents following a sudden faint while walking home from work. There were no prodromal symptoms, the episode lasted for only a couple of minutes, and he was not confused or drowsy afterwards.

His is otherwise asymptomatic, while his medical history and family histories are unremarkable.

He is not on any medications, does not smoke, and only drinks socially. There is no history of substance abuse.

His full blood count, random capillary glucose, serum electrolytes, and chest x-ray are normal, as are serial ECGs.

Select Relevant Investigations
Transesophageal Echocardiogram

Performed

Transesophageal echocardiography shows shows an intimal flap in the ascending aorta. Left ventricular hypertrophy is also noted. No other valvular or structural cardiac defects are present.
CT Thorax

Performed

The CT Scan of the thorax shows an intimal flap in the distal ascending aorta extending up to the inferior surface of the aortic arch.
D-Dimers

Performed

The D-Dimer assay is negative.
MRI Brain

Performed

You realize that an MRI of the brain would waste valuable time.

Select Relevant Management
Start Beta Blockers first
Start ACE Inhibitors first
Urgent Surgery
Anticoagulation