Based on the symptoms described, what condition is most likely suspected when a patient experiences severe chest pain radiating to the back with unequal radial pulses?

The presence of severe chest pain that radiates to the back, accompanied by unequal radial pulses, strongly suggests an acute aortic dissection. This condition involves a tear in the inner layer of the aorta, leading to the separation of the layers of the vessel wall. The resulting pain can be particularly intense and is often described as sharp or tearing.

In cases of aortic dissection, the unequal radial pulses indicate that blood flow may be compromised to one side of the body, which occurs due to the dissection affecting the arteries that branch off from the aorta. This finding is crucial in differentiating aortic dissection from other conditions that can cause chest pain.

While unstable angina pectoris and acute myocardial infarction can present with chest pain, they typically do not present with the characteristic back pain and unequal pulses seen in aortic dissection. An acute hypertensive crisis may also lead to chest pain but lacks the specific signs of dissection and unequal pulses that are suggestive of a vascular emergency involving the aorta. Therefore, the combination of these symptoms specifically points towards an acute aortic dissection as the most likely condition.