<prompt> Answer this question truthfullyWhat does chest pain without ST elevation mean?  <response>: <reason> Supportive symptoms and signs include the following: Back pain in 67 of cases Diminution or absence of pulses in 40 of case Coma, altered mental status, Cerebrovascular accident CVA and vagal episodes are seen in up to 20 Descending dissection can lead to splanchnic ischemia, renal insufficiency, lower extremity ischemia or pulse deficits or focal neurologic deficits due to spinal cord ischemia. Chest X-Ray Abnormalities Include: An increased aortic diameter is the most common CXR finding, seen in up to 84 of patients. A widened mediastinum is the next most common finding, seen in 15-20. Normal in 17. Pleural effusion hemothorax in the absence of CHF can also be another clue to dissection. Next Study to Do: MRI is currently thought to be the most sensitive noninvasive method of making the diagnosis of aortic dissection. As with CT, the diagnosis is made upon visualization of a double lumen with a visible flap. Sensitivity and specificity are both thought to be 98, and the site of entry can be visualized in 85 of cases. 