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Accessed Dec. Physical findings are less frequent in distal than in proximal dissection, so the diagnosis of distal dissection may be subtle and should be considered in patients who have histories of hypertension, are hypertensive at the time of pain, or have atypical chest pain worse when bend forward. Anginal pain is typically described as dull, heavy, or crushing. Show references Walls RM, et al. Related Articles. Because dissection requires immediate, specific treatment, the clinician must exclude this diagnosis early.