Q. A 45-year-old male is brought by ambulance to the emergency department with sudden onset chest pain radiating to the back. The patient states the pain began during his daily jog through the park. A chest x-ray of the chest shows a widened mediastinum. A scan is performed to confirm the expected diagnosis, which demonstrates aortic dissection. Which of the following co-morbidities is most directly responsible for this patient’s potentially fatal condition?