Dear Rakshith, Thanks for the Update here.

First of all REMEMBER : Normal ECG ≠ No MI

We recommend you following next steps immediately :

1️⃣ Assess Vitals & Risk Factors

→ DM, HTN, Smoking, Obesity, Family history

2️⃣ Cardiac Biomarkers

→ High-sensitivity Troponin (0 hr & 3 hr protocol)

3️⃣ Serial ECGs

→ Repeat every 15–30 min if pain persists

4️⃣ Pain Assessment

→ Nature, radiation, relation to exertion, relief with rest

5️⃣ Echocardiography (if available)

→ RWMA, LV function, Pericardial effusion

📌 Key Differentials to Keep in Mind

❤️ Cardiac Causes

1: NSTEMI / Unstable Angina

2: Microvascular Angina (Common in women)

3: Coronary Vasospasm (Prinzmetal)

4: Myocarditis

5: Pericarditis

6: Aortic Dissection (if severe tearing pain)

🫁 Pulmonary Causes

1: Pulmonary Embolism

2: Pneumothorax

3: Pneumonia / Pleurisy

🍽️ GI Causes

1: GERD

2: Esophageal Spasm

3: Peptic Ulcer Disease

🦴 Musculoskeletal

1: Costochondritis

2: Muscle strain

🧠 Others

1: Panic Attack / Anxiety

2: Herpes Zoster (Pre-eruptive phase)

🎯 Bottom Line

👉 Normal ECG does NOT rule out ACS

👉 Always do Troponin + Serial ECG + Risk Stratification

👉 Observe if in doubt — Don’t discharge early

Team Medicoz Community