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This chapter discusses the diagnosis, evaluation and management of aortic dissection. In addition to chest pain, patients may present with focal neurological deficits secondary to the physical obstruction of either one of the carotid arteries by an intimal flap, or false lumen propagation. Vascular obstruction and ischemia may occur at any level, leading to syncope, stroke symptoms, acute myocardial infarction (frequently from right coronary artery compromise), mesenteric ischemia, paraplegia (from hypoperfusion of the spinal arteries), or limb ischemia. Cardiogenic shock may also arise as a complication of dissection into the pericardium resulting in cardiac tamponade. Beck's triad of hypotension, muffled heart sounds, and jugular venous distension can sometimes be found. Electrocardiogram (ECG) findings rarely aid in the diagnosis, though ST elevations may be present in as many as 20% of patients due to ostial coronary involvement.