You are treating a 67 year old male complaining of chest pain. He rates the pain at a 10/10 and describes the pain as a tearing sensation that he also feels in his back and shoulders. Your assessment reveals that the patients blood pressure is 30mmHg lower in his left arm than his right arm. You should suspect:

A. Left ventricular heart failure

B. Acute pulmonary embolism

C. Acute myocardial infarction

D. Acute aortic dissection