Aortic dissection is the most common emergency affecting the aorta. It is rare below the age of 40 and carries a high mortality. Diagnosis can be difficult and a high index of suspicion is essential. Over the years several different classifications have been employed including BeBakey, Stanford and more recently the SVS classification. The clinical presentation is variable but the majority of patients present with severe, sudden chest or back pain. Despite the known relationship between hypertension and aortic dissection, blood pressure can be variable on initial presentation. Pseudohypotension may occur if the upper limb arteries are involved in the dissection. Peripheral branch involvement is common, occurring in 30-50% of cases. Full history and physical examination are essential and investigations should include ECG, echocardiography and CTA. Treatment options are dictated by whether it is a Type A or a Type B dissection and a multi-disciplinary approach is recommended. Late complications include aneurysmal dilatation and possible late rupture. Recent trials have shown encouraging result for endovascular management. Despite advances in both medical and surgical management mortality remains high and further research and collaborative management are essential.