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

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.