However some symptoms do include severe chest pain, cough, shortness of breath, difficulty swallowing due to compression of the esophagus, back pain, and hoarseness due to involvement of the recurrent laryngeal nerve.[4] There might be external signs such as bruising on the anterior chest wall due to a traumatic injury.[9] Clinical signs are uncommon and nonspecific but can include generalized hypertension due to the injury involving the sympathetic afferent nerves in the aortic isthmus.[9] A murmur can also be audible as turbulent blood flow goes over the tear.[9]