Aortic dissection is the pathology of higher mortality among the acute aortic syndromes of sudden onset of chest pain, being 1% per hour in the first 48 hours and 75% at the end of the second week. Less than 10% of untreated patients survive for one year. So it is necessary to know the pathophysiology, classification, clinical presentation and differential diagnosis of this disease, so the diagnosis is evident, thus ensuring proper management and the best outcome of the clinical condition. Therefore, the aim of this review article is to provide a diagnostic and therapeutic strategy organized to the professional, directing the medical knowledge to the clinical manifestations and initial therapeutic approach with speed, quality and efficiency of care in the emergency room.