A woman in her 70s presented to the emergency department with 4h of dizziness, headache and epigastric discomfort. Her only medical history was hypertension. The blood pressure was 89/45mmHg, pulse 58 beats per minute, oxygen saturation 98% in ambient air. Electrocardiogram (ECG) showed sinus bradycardia and non-specific ST-T abnormality. Initial troponin was not elevated. Contrast computed tomography (CT) of the aorta was performed to exclude dissection (Fig. 1).