Aortic Dissection

Frank is a 64-year-old male presenting with sudden onset tearing chest pain radiating to the back. About two hours ago I was lifting groceries out of my car when I suddenly felt the most horrific pain I have ever experienced in my life. It started in the front of my chest and immediately went straight through to my back, right between my shoulder blades. The best way I can describe it is a tearing or ripping sensation — it literally feels like something inside me is being ripped apart. Your task is to take a focused history from this patient.