MedPrep Pro

The patient's presentation is classic for aortic dissection, which is characterized by sudden onset of severe chest pain that often radiates to the back. The blood pressure discrepancy between arms (>20 mmHg difference) is highly suggestive of dissection involving the aortic arch. The diastolic murmur suggests aortic regurgitation, which can occur when the dissection involves the aortic root and disrupts the aortic valve. Acute myocardial infarction (A) would not typically cause a blood pressure discrepancy or diastolic murmur. Pulmonary embolism (C) usually presents with dyspnea and hypoxia. Pericarditis (D) typically causes positional chest pain and a friction rub. Esophageal rupture (E) usually occurs after vomiting and may cause subcutaneous emphysema.