An Unusual Presentation Of Painless Myocardial Infarction To The Emergency Department

Myocardial Infarction presenting without chest pain is not uncommon in the Emergency Department. We present a case of painless myocardial ischemia in a patient with a complex background of chronic pain whose perception of pain was possibly altered by the use of high doses of opioid analgesics. The significance of early diagnosis of silent ischemia and the pit falls for physicians working in the emergency department are discussed. The importance of simple tests like an electrocardiogram in the overall assessment of patients presenting with a blurred history is also highlighted.