Atypical Presentation of Acute Myocardial Infarction As Syncope and Abdominal Pain in the Absence of Chest Pain or Discomfort

TL;DR

A heart attack can present as fainting and stomach pain instead of chest pain, especially in patients with certain risk factors.

Contribution

This case highlights the importance of considering heart attacks even when chest pain is absent.

Findings

Acute myocardial infarction presented as syncope and abdominal pain without chest discomfort.

ECG confirmed an inferior ST-segment elevation myocardial infarction.

Early recognition and treatment are crucial to prevent increased morbidity and mortality.

Abstract

Atypical presentations of acute myocardial infarction can make early diagnosis challenging, particularly when chest pain or discomfort is absent. We present a case of a 60-year-old man with diabetes, hypertension, a previous myocardial infarction (MI), and heart failure with reduced ejection fraction who presented with syncope and severe abdominal pain but no chest pain or discomfort. The ECG demonstrated an inferior ST-segment elevation myocardial infarction. He received dual antiplatelet therapy and anticoagulation before emergent transfer for coronary angiography, which revealed right coronary artery occlusion.

‎We concluded that acute myocardial infarction can present without chest pain or discomfort and instead manifest with syncope and/or abdominal pain, especially in patients with risk factors for atypical presentations. Clinicians should maintain a high index of suspicion for acute coronary syndrome in such cases to avoid delays in diagnosis and reperfusion therapy, as delays may increase morbidity and mortality.

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