A 62-year-old man with a history of hypertension and hyperlipidemia presents to the emergency department with sudden onset, severe, tearing chest pain radiating to his back. His blood pressure is 180/100 mmHg in the right arm and 160/90 mmHg in the left arm. Heart rate is 98 bpm. ECG shows no acute ischemic changes. What is the most appropriate initial management step?
✓ Correct Answer: Option B
The patient's symptoms (tearing chest pain radiating to the back, pulse deficit, differential blood pressures) are highly suggestive of acute aortic dissection. The most critical initial management is aggressive blood pressure and heart rate control to reduce shear stress on the aorta.