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the authors report on a rare case of acute myocardial infarction associated with dissection of the aortic arch. Treatment and differential diagnosis are presented. Early administration of fibrinolytic agents is undoubtedly an effective therapy of acute myocardial infarction, which considerably increases survival rate in these patients. Yet, the physician should always be alert to the serious, even fatal danger of using this therapy in aortic dissection, which is sometimes very difficult to differentiate from fresh myocardial infarction.