Aortic dissection in the most common fatal disease affecting the aorta. Ascending aortic dissection can lead to coronary malperfusion causing myocardial infarction with ST elevation. The distinction between aortic dissection and a primary myocardial infarction can be difficult because both conditions can have similar presentations. Making the right diagnosis is essential because the therapies used to treat myocardial infarction can be fatal for patients with aortic dissection. Emergency transthoracic echography presents a rapid imaging procedure that provides strong hints of the coexistence of these two diseases, leading to further imaging examination and prevent inappropriate administration of treatments that could cause catastrophic outcome. We report a case of a 62-year-old man admitted to our hospital with chest pain, who was diagnosed as inferior wall myocardial infarction based on electrocardiographic findings. The diagnosis was reassessed due to a significant aortic regurgitation and an intimal tear in the ascending aorta on transthoracic echocardiography. Computed tomography angiogram of the chest and transesophageal echography fully confirmed the presence of ascending aortic dissection. Emergency surgery was successfully performed and the patient recovered well.