Tomás, a 68-year-old man with a history of long-standing hypertension, is brought to the emergency department by his daughter after he suddenly grabbed his chest and back and described the pain as "tearing" and unlike anything he has felt before. His BP is 168/98 in the right arm and 132/78 in the left arm, HR is 108 bpm, and he appears pale and diaphoretic. He denies any recent trauma or exertion before the pain started. The nurse recognizes that the discrepancy in blood pressure readings between Tomás's arms is most consistent with which underlying process?
- Vasospasm of peripheral arteries triggered by pain and anxiety
- Aortic dissection extending into branch arteries and altering arm blood flow
- Rupture of a cardiac valve leaflet causing sudden regurgitant flow
- Acute coronary artery occlusion reducing myocardial perfusion