Your choice: Aortic dissection
Patients with aortic dissection typically present with chest pain that has a tearing quality, is abrupt in onset, radiates to the back and is not related to respiration or position. It usually occurs in a patient with hypertension or is a result of trauma. It may also present with features indistinguishable from an acute myocardial infarction. In patients less than fifty years of age, such as those with Marfan's syndrome, the absence of hyperension does not exclude the diagnosis.