Here’s an article with a lot of great numbers to keep you from sleeping well at night. It’s a prospective look at the symptoms patients present with when their eventual diagnosis is STEMI or NSTEMI. 6.4% of their STEMI patients and 5.6% of their NSTEMI patients didn’t complain of any chest symptoms (pain, pressure, etc.). There’s a lot of arm pain, epigastric pain, shoulder pain, and then multiple anginal-equivalents on their list of symptoms, but it’s a great example showing that if you write off ACS in your patients without chest pain, you’re going to get burned – 1 in 16 STEMIs in their cohort. Even better, only 45.1%/53.9% of their patients thought their symptoms were cardiac related, which probably means there’s a population of STEMIs just sitting at home figuring they’ll feel better in the morning….