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Type A aortic dissection is usually difficult to diagnose immediately, especially in pain-free patients, leading to catastrophic outcome. Varied presentations had been reported in previous articles including complete atrioventricular block and supraventricular tachycardia. There were no previous reports regarding painless aortic dissection presenting with bigeminal premature ventricular contractions. Here, we report a case of a 55-year-old man who had syncope with bigeminal premature ventricular contractions on initial electrocardiogram at the emergency department, and finally was diagnosed as having aortic dissection by echocardiography.