Due to the old diagnostic method and the clinician’s level of treatment, it is common to misdiagnose non-coronary heart disease as coronary heart disease, but it is rare to misdiagnose coronary heart disease as other diseases due to atypical chest tightness and discomfort. Ms. Zhang, 71 years old, was admitted to the hospital on April 10, 2004 with “recurrent chest tightness, shortness of breath with panic and weakness for 3 years, aggravated for 2 months”. “. The diagnosis was “coronary artery disease? In the morning of August 10, 2001, he had sudden shortness of breath, chest tightness, panic, weakness, polyuria and dizziness, and was seen in the emergency department of the hospital. He was treated as “hypertension” and his symptoms disappeared quickly. Later on, he continued to have similar symptoms and a feeling of tightness in the chest, which was tolerable. In the morning of March 7, 2002, the above-mentioned symptoms occurred again, and he was diagnosed as “anxiety disorder” by the neurology department. He started treatment with Dianxin, Gaglodin, Glutathione and Danshen Drops. On the morning of May 11, 2002, he visited the emergency room again with the above symptoms, the ECG was normal, he was advised to continue the Chinese medicine treatment and was referred to the psychology department. “Sellett”. Two hours after taking the drug, the patient developed paroxysmal chest burning, generalized irritability, palpitations, shortness of breath, profuse sweating on the head and face, dry mouth and tongue, generalized weakness, and a heart rate of 110 bpm. On March 7, 2004, the patient was admitted to the Department of Cardiology again after waking up with the same symptoms as in 2001. After admission, 24-hour ambulatory electrocardiogram (Holter) and echocardiogram (UCG) were performed without any abnormality; exercise plate test suggested ST segment downshift of 0.1 mV in V5V6 leads, and there was no angina attack during exercise. The diagnosis of coronary artery disease was considered insufficient, and the patient was treated with anxiety disorder and started to take Prozac on March 8. At the beginning, he had chest tightness and palpitations once every 2 to 3 days, but later he had several attacks every day. Past conditions: history of conductive deafness for more than 50 years, history of chronic gastritis for 3 years, denied other medical history. He was admitted to our hospital with the following symptoms: mental clarity, poor spirit, depression, lazy speech, weakness, a little dizziness and headache, chest tightness, dry mouth and little drinking, deafness, no fever, no palpitation, shortness of breath, sweating, poor sleep, and bowel movement. BP at admission: 145/65 mmHg, clear, tired, wasted, heart border was not large, heart rate was 72 beats/min, rhythm was irregular, premature beats could be heard, about 2/min, no pathological murmur was heard in each valve auscultation area, other abnormalities were not seen. TCD: Bilateral carotid artery sclerosis and calcified plaque formation in the right common carotid artery. UCG: left ventricular myocardial hypertrophy, small thinning of the anterolateral wall of the apical region, and hypokinesis. Holter: frequent ventricular premature, occasional supraventricular premature beats, short burst atrial tachycardia, and no significant ST-T changes. Lipids, blood glucose, blood uric acid, cardiac enzymes, and troponin were normal. Admission diagnosis: “1, chest tightness to investigate the cause, coronary heart disease; 2, hypertension grade 1; 3, chronic gastritis; 4, senile anxiety disorder; 5, conductive deafness”. The patient was admitted to the hospital with recurrent episodes of chest tightness and discomfort with symptoms similar to those before admission, about 4-6 episodes in 24 hours, each of varying duration, more so in the early morning after waking up from sleep, repeatedly with no change in ECG and cardiac enzymes during the episodes, relieved by taking chest nitrates and acupuncture of Hegu and Neiguan. In order to clarify the diagnosis of anxiety disorder, the patient underwent anxiety self-assessment scale (SAS) measurement, and the SAS score was 21, excluding anxiety disorder. Because the patient’s chest tightness did not resemble a typical angina attack, the clinical diagnosis failed to exclude coronary artery disease, and a coronary angiography (CAG) was performed on April 14, 2004. The results showed that the proximal anterior descending branch of the left coronary artery was located at the opening of the first diagonal branch with limited 70% stenosis; the left main trunk, gyral branch and right coronary artery were all free of stenosis and the blood flow was smooth. A stent was placed directly in the anterior descending branch, and there was no residual stenosis after stent release. After the operation, the patient stopped taking all anti-anxiety drugs and the chest tightness was reduced. He was discharged 2 weeks after the operation and had no more episodes of chest tightness. The incidence of both anxiety disorders and coronary artery disease is rapidly increasing in elderly women. There are many cases of misdiagnosis of anxiety disorders as coronary heart disease because of palpitations, precordial or left chest pain, chest tightness, shortness of breath, tightness, with symptoms such as nervousness, cold sweat, and pallor, and so on. Myocardial ischemia in the elderly is not characterized by exertional angina, and is often misdiagnosed due to atypical symptoms. In this case, the patient had a missed diagnosis of coronary artery disease because of atypical symptoms, no ischemic ST-T changes during the attack, and no CAG examination was performed. The diagnosis of anxiety disorder was made without SAS examination, and the psychiatrist made the diagnosis based on experience only, which led to a misdiagnosis. From the diagnosis and treatment of this patient, it is clear that for elderly patients with atypical clinical symptoms of coronary artery disease and laboratory findings that are insufficient to diagnose coronary artery disease, coronary angiography is recommended to avoid misdiagnosis and omission and reduce the occurrence of cardiac events.