Case of chest pain at primary healthcare centre walk-in clinic.50-year-old male, active smoker, history of hypertension, hypothyroidism. Ramipril 10mg, amlodipine 5mg, eutirox 200 µg. Chest pain which initiated during the night, while at rest. Irradiates to upper abdomen, bilateral neck, left jaw. Improves in right lateral decubitus. Worsens on sitting and on anterior inclination. VAS 8 (0-10). BP 119/60 – 150/100 mmHg   SpO2: 95%  glycemia 142 mg/dL Unremarkable physical examination. EKG: RS 70 bpm, PR 0.20s, narrow QRS, negative T waves in inferior leads. Emergency referral to hospital: Troponin <14  Creatinine 1.63 mg/dL GFR 48 mL/min CRP 0.26 mg/dL CBC, LFT: normal Chest X-ray: unremarkable Serial troponin: <14  – Paracetamol IV: partial improvement, isolated vomit, anxious patient. Difficulty urinating. Impression: – Mild impairment of kidney function – Atypical chest pain – Possible anxiety component He wishes to be discharged and in light of absence of data suggestive of ACS, he is discharged, instructed to follow-up with his PCP. FOLLOWING DAY: He returns to the healthcentre seeking medical leave. Persistent thoracoabdominal pain with poor food tolerance, profuse cold sweats, fever, and weakness in the lower extremities. Urgent reassessment. EKG repeated, no changes. DD: – Acute gastritis – Pancreatitis – Gastrointestinal perforation Patient referred again to hospital, abdominal CT scan was performed: Stanford Aortic dissection, from the aortic root to the infrarenal descending aorta. The dissection extends to the brachiocephalic trunk, celiac trunk, and superior mesenteric artery. Celiac trunk with dissection extending to a few centimeters distal to the ostium, showing proximal thrombosis within the false lumen. Right renal artery originates from the false lumen. 12h emergency surgery.Aortic dissection is not something you see every day. Especially at the primary healthcare level.The importance of considering every piece of medical information is underscored by this case. What could explain the kidney function impairment? How could he have been discharged in the face of the puzzling clinical presentation?More frequently than not, once acute coronary disease is ruled out, chest pain is relegated to the Realm of Anxiety.Vital that care providers consider potentially fatal diagnoses when confronted with puzzling presentations.