Aortic dissection presenting as concomitant stroke and STEMI

Aortic dissection is a disease of immediate consequence,as mortality of a proximal dissection is in excess of 50% when left untreated. Early recognition of the dissection event can lead to faster definitive correction with surgical and/or novel percutaneous approaches. Widely varying signs and symptoms can, however, make this diagnosis a challenge, further complicated by the fact that no specific imaging modality is ideal, nor immediately available, in all cases. Care must be taken inpatients where methodical evaluation is difficult,including physical exam, standard electrocardiogram and chest X-ray, before more definitive imaging. This is a case of aortic dissection that is presented as concomitant ST elevation myocardial infarction and embolic stroke, in which the patient received thrombolytics before diagnosis of the dissection itself. This arguably may have worsened her clinical course.