Aortic dissection is urgent, serious, life-threatening condition which without medical intervention in most cases has a fatal outcome. Most often it is a complication of poorly controlled hypertension. We present a rare case of acute dissection of the ascending aorta that led to sudden death due to retrograde involvement of both left and right coronary arteries and development of acute myocardial ischemia in a man with history of prolonged opioid drug abuse. A full forensic examination was performed – anamnestic, medical and criminology data was collected, a toxicological analysis of blood and urine samples was made, as well as comparison of the macroscopic findings and the histological changes in the affected organs.
 

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