Aortic Dissection Mimicking Myocardial Infarction: The Diagnostic Value of Point-of-Care Echocardiography

Aortic dissection (AD) is a life-threatening condition often misdiagnosed due to its varied presentation and symptom overlap with more common emergencies. This delay in diagnosis significantly increases morbidity and mortality. We report the case of a 53-year-old man with a history of hypertension who presented with central chest pain and was initially diagnosed with an inferior ST elevation myocardial infarction based on electrocardiographic findings. During cardiac catheterisation, difficulty in engaging the right coronary artery was noted, prompting a bedside transthoracic echocardiogram (TTE), which revealed a Stanford Type A AD extending from the aortic root to the abdominal aorta. The patient experienced ventricular fibrillation and cardiac arrest but was successfully resuscitated and immediately transferred for surgical repair. His postoperative course was complicated by multifocal cerebral infarcts requiring prolonged ventilatory support and tracheostomy. This case highlights the crucial importance of maintaining a high clinical suspicion for AD, particularly when initial presentations are atypical or defy conventional diagnostic algorithms. We emphasise the pivotal role of early point-of-care echocardiography in rapidly confirming the diagnosis, thereby reducing delays to life-saving interventions. This significantly improves patient outcomes even in complex clinical scenarios. We also provide a practical guide for frontline clinicians to diagnose Type A AD using transthoracic echocardiography.