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A 47-year-old female presented with epigastric pain and elevated troponin I levels. The case highlights the importance of considering acute coronary syndrome in patients with atypical symptoms, guiding emergency medical services transport decisions.

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Area of Science:

  • Emergency Medicine
  • Cardiology
  • Pre-hospital Care

Background:

  • Acute coronary syndrome (ACS) can present with atypical symptoms such as epigastric pain, particularly in women.
  • Early recognition and appropriate transport decisions are critical for optimizing outcomes in patients with suspected myocardial infarction.

Purpose of the Study:

  • To evaluate the diagnostic challenge of atypical presentations of acute coronary syndrome in the pre-hospital setting.
  • To determine the optimal transport strategy for patients with suspected ST-elevation myocardial infarction (STEMI) based on emergency department capabilities.

Main Methods:

  • A 47-year-old female presented with sudden onset epigastric pain and vomiting.
  • A 12-lead electrocardiogram (ECG) revealed nonspecific inferior ST-T wave changes.
  • Field-drawn blood analysis showed a markedly elevated cardiac enzyme (troponin I).

Main Results:

  • The patient's clinical presentation, ECG findings, and elevated troponin I levels were highly suggestive of an acute myocardial infarction.
  • The case presents a dilemma regarding transport to a closer facility without primary percutaneous coronary intervention (PCI) or a further facility with PCI capabilities.

Conclusions:

  • This case underscores the importance of considering ACS in patients with non-classic symptoms.
  • The decision on transport destination should weigh the benefits of rapid PCI against the risks of delayed treatment and transport time.