Q. A 56-year-old man comes to the emergency department because of “tearing” chest pain. The pain started one hour ago and is now radiating to his back. His past medical history is significant for hypertension, diabetes, and chronic hepatitis C infection. Vital signs reveal a blood pressure of 170/70 mm Hg, heart rate of 100/min, respiratory rate of 15/min, and a temperature of 36.7 degrees Celsius. Pulses are unequal in his upper extremities. Transesophageal echocardiography shows a true and false lumen in the ascending aorta. Which of the following is expected in this patient's cardiac examination?