A 57-year-old man presents with sudden onset of severe and central chest pain radiating to the back. ECG shows ST segment elevation in lead V1-V6, I, aVL. The chest X-ray shows a widened mediastinum. The diagnosis is:

Ans. A. Aortic dissectionRef: CMDT 2019 pg. 496The ECG finding of ST Elevation prompts diagnosis of Myocardial infarction. But the CXR showing mediastinal widening is the key word which favors diagnosis as tear in the aorta.The answer is aortic dissection which exhibits a retrograde extension that can affect the coronary artery and can explain the resultant MI in this patient.