An

82-years-old retired solicitor presents to the ED with chest pain radiating to

his jaw. He has hypertension treated with ramipril 5 mg bid (ACE inhibitor) but

is otherwise normally fit and well. His admission ECG shows sinus rhythm with

ventricular rate of 57 bpm, LV hypertension, and widespread ST segment

depression. His peak troponin is 110 ng/l (normal <30 ng/l). He is started

on treatment for an acute coronary syndrome and listed for an inpatient

angiogram. You are asked to perform bedside echocardiogram as a systolic murmur

is heard on the post-take ward round. His aortic valve is heavy calcified,

maximal trans-aortic jet velocity is 4.3 m/s, peak trans-aortic gradient is 75

mmHg, mean trans-aortic gradient is 46 mmHg (Figure below). 

Please name the type of aortic dissection shown below:

An 80-year-old

woman is admitted with acute pulmonary oedema on a background of progressive

shortness of breath with exertional chest pain for 6 months. She has a history

of renal impairment with a eGFR of 40 ml/min. She is initially commenced on IV

furosemide with good effect. An echocardiogram reveals LVEF 40% with severe

aortic stenosis (AS) with an estimated valve area of 0.7 cm2. She is on sinus

rhythm, 90 bpm. What would you do next?

Please identify the correct diagnosis based on images below a) chest x-ray (left) and b) computed tomography image (right).