We describe a case of a 70 years old female patient in whom an initial diagnosis of acute coronary syndrome (ACS) revealed to be finally an acute aortic dissection. This case report emphasizes the importance to maintain a high grade of suspicion of aortic dissection as a possible alternative in presence of electrocardiographic myocardial ischemic changes. In many medical centers where thrombolytic therapy, antiplatelet receptor blockers, heparin or percutaneous coronary angioplasty is the first line therapy for ACS the outcome may be catastrophic in situation such as in aortic dissection.
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