This study is about an infrequent first presentation of Aortic Dissection (AD), and it is primary Ventricular Fibrillation (VF). We present a 64-year-old woman with a history of hypertension who came with sudden retrosternal chest pain, dizziness, nausea, and vomiting. The patient suffered a cardiac arrest a few seconds after admission. Cardiopulmonary resuscitation (CPR) was done for her. An electrocardiogram (ECG) showed ST elevation that demonstrated acute anterior MI (Myocardial Infarction). Trans-thoracic echocardiography (echo) CT angiography demonstrated decreased left ventricular ejection fraction with normal LV size (LVEF=25%) and type A Stanford and type I DeBakey aortic dissection flap from root up to distal of abdominal Aorta. This is while the patient's first presentation was VF, and she had anterior MI, which is unusual for aortic dissection. Therefore, we must consider AD in patients with VF. We have to consider AD in anterior MI patients because of the contraindication of medication.