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Atypical STEMI — DipIMC MCQ

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ModerateMedical EmergenciesAtypical STEMIDipIMC

A 54-year-old man has epigastric pain, sweating and vomiting. He denies chest pain, but ECG shows anterior ST elevation. What is the most appropriate transport decision?

Educational content. Not a substitute for clinical judgement or local policy.

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Correct answer: A — Activate the STEMI pathway despite atypical symptoms

Myocardial infarction can present with epigastric pain, sweating or vomiting, and ST elevation on ECG should activate the reperfusion pathway. Absence of classic chest pain is not reassuring. Delayed repeat ECG or antacid treatment risks myocardial loss. The pearl is that the ECG can trump symptom labels in acute coronary syndromes.

Reference: JRCALC Guidelines 2025; NICE Acute Coronary Syndromes NG185