A 40-year-old male with c...

A 40-year-old male presented with chest uneasiness for the past 2 hours. His vital signs upon arrival were blood pressure of 260/156 mmHg, heart rate of 130 beats per minute in a regular rhythm, jugular venous pressure not raised, clear chest auscultation, and cardiovascular examination revealing S1S2 sounds. No other systemic involvement was noted. Initial two ECGs, conducted at 30-minute intervals, demonstrated normal sinus rhythm with no ST elevation or T-wave changes. Meanwhile, the patient was managed with nitroglycerin infusion, resulting in controlled blood pressure. Despite this, due to persistent minimal chest uneasiness, a third ECG was performed after 2 hours, revealing sinus tachycardia, RBBB, and ST elevation in anterior leads suggestive of ACS. Subsequently, the patient received antiplatelets and anticoagulants and underwent CAG/PTCA, ultimately saving his life. This case serves as a crucial reminder to maintain a high index of suspicion for ACS, emphasizing the importance of not dismissing symptoms solely based on an apparently normal initial ECG. Regular monitoring with serial ECGs, cardiac enzymes, and timely coronary angiography are essential for accurate diagnosis and intervention.