53y/o obese woman with HTN is brought to ER. Had excruciating stabbing like chest pain readiating to left arm. Puls 110, BP is 160/80. Heart souds distant, pulsus paradoxus persent. ECG shows low voltage ST-T wave changes. Xray shows widening of mediastinum. Most likely dx: a. aortic disssection with cardiac tamponde b. massive pulmonary thromboembolism c. MI with congestive failure d. rupture of papillary muscle Guys, is the answer really A? Do you ohave ST elevations in aortic dissection and/or cardiac tamponade? I didnt think this was possible, could someone pls help me on why it cant be the other choices, epecially C and D???? Dont you get lowered BP in aortic dissection and cardiac tamponade???