Abstract

Background: Acute myocardial infarction (AMI) may present with non-specific symptoms and initially normal electrocardiographic findings, leading to potential misdiagnosis and delayed treatment. Case Presentation: A 45-year-old previously healthy male presented to the emergency department with central chest discomfort described as burning, initially attributed to gastroesophageal reflux disease (GERD). Initial vital signs were stable, and the first electrocardiogram (ECG) showed no significant abnormalities. Laboratory investigations, including initial cardiac biomarkers, were within normal limits. Despite symptomatic treatment, the patient continued to experience chest discomfort. A repeat ECG performed two hours later demonstrated ST-segment elevation in the anterior leads. Subsequent troponin levels were elevated, confirming the diagnosis of acute ST-elevation myocardial infarction (STEMI). The patient underwent urgent coronary intervention with successful revascularization. Conclusion: This case highlights the critical importance of serial ECG and repeated clinical evaluation in patients with persistent chest pain, even when initial findings are unremarkable. Early recognition of evolving myocardial infarction is essential to prevent adverse outcomes.