**4. Clinical presentation**

TAAD patients (85%) typically present with sudden intense central chest pain (ripping or tearing) radiating to the neck, back or abdomen. [11]. ECG abnormalities (50% patients) include ST/T wave changes, conduction defects, and arrhythmias. This sometimes leads to the misdiagnosis of myocardial infarction leading to fatal mistake of giving antiplatelet therapy or thrombolysis. This delays the diagnosis and increases peri-operative bleeding complications. Aortic regurgitation (70% patients) can occur through prolapse of right or non- coronary valve cusps and detachment of commissures. Pulmonary oedema may occur through acute dilation of the left ventricle. Haemorrhagic pericardial tamponade is a very strong predictor of aortic dissection. Reduced or absent femoral pulses are seen. Neurological sequlae include syncope, stroke. Mal-perfusion of spinal cord leads to paraplegia. Acute renal failure and mesenteric ischemia are seen if the dissection involves descending thoracic and abdominal aorta [12]. Rupture of the aneurysm is immediately fatal.
