Thoracic aortic dissection presenting as acute coronary syndrome

A patient presented with symptoms consistent with non-ST elevation myocardial infarction (NSTEMI) and was given appropriate antiplatelet and anticoagulant therapy. Despite treatment of the NSTEMI and fluid resuscitation the patient remained persistently hypotensive. Further imaging demonstrated an extensive Stanford type A dissection extending from the aortic root to the left common iliac artery. The patient was taken to theatre and had an emergency hemiarch replacement with repair of the aortic root. Post surgery the patient had an uneventful recovery. We present this case to highlight the importance of considering dissection as a differential in patients presenting with chest pain and the lack of symptoms a patient with such a severe dissection can display.