Case 85-year-old grandmother Liu, who has suffered from diabetes and hypertension for many years, but has been taking regular medication and insisted on taking aspirin, etc. Usually, there is no obvious chest discomfort and her daily activities are not much. However, 3 days ago, when Grandma Liu woke up in the morning, she suddenly fainted and was sent to our hospital by her family. The attending emergency department doctor suspected that she had an acute myocardial infarction and immediately did an electrocardiogram test, the results of which confirmed the doctor’s suspicions. The hospital then immediately started a green channel and had a cardiologist open the occluded right coronary artery for Grandma Liu, turning her into a patient. Now, Grandma Liu has been discharged from the hospital, but she keeps asking herself how she got myocardial infarction: “I don’t have chest pain, right? Every year, I have an electrocardiogram, and the doctor told me that there is no big problem with my heart, right?” Generally speaking, patients with acute myocardial infarction have sudden anterior sternal crushing pain that lasts for more than 20 minutes and cannot be relieved, and their chest seems to be pressed to catch breath, accompanied by profuse sweating, pallor, fear and a sense of near death, which are typical symptoms of heart attack. However, myocardial infarction is not the main manifestation of chest pain, and atypical infarction is also common in clinical practice, with a variety of symptoms: firstly, some people will show syncope like Grandma Liu; secondly, some show symptoms such as sudden onset of chest tightness and difficulty in breathing, or panic and shortness of breath during activities, with a tendency of gradual aggravation; again, some patients go to the doctor because of nausea and vomiting to go to the doctor, and as a result, heart attack was found on examination; there are also patients with epigastric pain at the onset, as well as persistent jaw pain, toothache and sore throat. There are mainly the following reasons why heart attack patients do not have typical symptoms such as chest pain: First, the lesion sites are different, some are in the right coronary artery, some are posterior wall myocardial infarction, and some are subendocardial myocardial damage, and the distribution of the nerve network reflecting pain is different in different patients, so some parts of the heart attack do not feel pain significantly, or even do not appear painful. Secondly, painless infarction is mostly seen in elderly people who also suffer from chronic diseases such as diabetes and hypertension. These patients have a wide range of vascular lesions, and myocardial ischemia, injury and necrosis are much more serious than those of ordinary patients. At the same time, patients with hypertension and diabetes are often accompanied by impairment of nerve function, resulting in dull or even no pain sensation. Third, certain external factors, such as alcohol, excessive stress, fatigue, and changes in mood, can affect the patient’s sensitivity to pain and mask the condition. It should also be noted that very often, before the onset of heart attack, the ECG and so on are likely to be undetectable for significant myocardial ischemia. This also tends to make people let their guard down and often do not think they are having a heart attack when the atypical symptoms mentioned above occur. There is conclusive evidence that 50% of patients with coronary heart disease experience myocardial infarction and sudden death at the first onset. Therefore, the above-mentioned high-risk groups, once they have atypical symptoms such as chest tightness and abdominal pain, should seek timely medical consultation and make the most accurate diagnosis under the guidance of doctors to avoid delaying the treatment.