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Acute aortic dissection (AAD) is the most fatal aortic condition and is frequently overlooked during initial clinical presentations. Aortic dissection associated with acute coronary syndrome (ACS) is relatively rare but can pose diagnostic challenges and prove highly fatal. Retrograde extension of AAD may result in partial or complete occlusion of coronary vessels. Documented cases exist involving aortic dissection presenting as ST-segment-elevation myocardial infarction, with the right coronary artery being most commonly affected. A middle-aged woman with no comorbidities presented to the emergency department with sudden onset substernal chest discomfort radiating to her back and breathlessness for the past 5 hours. She had a tall and thin build and appeared anxious, diaphoretic, and orthopneic. Her vitals revealed tachycardia with a heart rate of 124 beats per minute and a systolic blood pressure of 80 mm Hg. Auscultation revealed a soft early diastolic murmur with fine crepitations at the lung bases. The chest X-ray indicated acute pulmonary edema and a widened mediastinum. The 12-lead ECG (Figure 1. A) demonstrated sinus rhythm with ST depression in leads II, III, aVF, and V3--V6 and ST elevation in leads aVR and I, indicating ACS involving the left main coronary artery (LMCA). Emergency endotracheal intubation was performed, and inotropes were initiated as stabilizing measures. The duty cardiologist was notified, and the catheterization laboratory was activated in anticipation of emergency coronary intervention. Concurrently, a point-of-care 2D transthoracic echocardiography was conducted, revealing severe left ventricular dysfunction (left ventricular ejection fraction =30%) with global left ventricular hypokinesia, a tricuspid aortic valve, and severe acute aortic regurgitation. Upon meticulous examination, an oscillating flap-like structure was identified in the ascending aorta (Figure 1. B-F). AAD was suspected, and an emergency multidetector computed tomography (CT) aortogram validated the diagnosis of Stanford type A AAD with a curvilinear dissection flap extending from the ascending aorta, involving the aortic arch and reaching the right common femoral artery. The intimal flap occluded the LMCA, leading to hypoperfusion in the supplied territory and causing severe left ventricular dysfunction (Figure 2 A-E) (Video 1). The attending cardiothoracic and vascular surgeon was promptly notified, and the patient was transferred for emergency surgery. [ABSTRACT FROM AUTHOR]